{ "hospital_name": "Santa Monica UCLA Medical Center and Orthopaedic Hospital", "last_updated_on": "2025-03-29", "as_of_date": "2025-01-01", "version": "2.0.0", "hospital_location": [ "UCLA Santa Monica Medical Center" ], "hospital_address": [ "1250 16th Street, Santa Monica, CA 90404" ], "license_information": { "license_number": "930000049|CA", "state": "CA" }, "affirmation": { "affirmation": "To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated.", "confirm_affirmation": true }, "standard_charge_information": [{ "description": "0.9% SODIUM CHLORIDE--CONTROL FOR ATG", "drug_information": { "unit": "0.100000", "type": "UN" }, "code_information": [ { "code": "63323018610", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 188.77, "gross_charge": 40.0, "discounted_cash": 22.0, "setting": "outpatient", "payers_information": [ { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.92, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.56, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.4, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.56, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.0, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.64, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.69, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.0, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.76, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.17, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.27, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.4, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.48, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.44, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.0, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.0, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.2, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.27, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.23, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.6, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 188.77, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.2, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.67, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.2, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.2, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.8, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.33, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.43, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.48, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.28, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.0, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.0, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.8, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.52, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.0, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.2, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.74, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.2, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.66, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" } ], "additional_generic_notes": "" } ] }, { "description": "2d tte w or w/o fol w/con,co", "code_information": [ { "code": "C8923", "type": "HCPCS" } ], "standard_charges": [ { "minimum": 0.339, "maximum": 0.85, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "outpatient", "payers_information": [ { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", 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"additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.75, "standard_charge_percentage": 75.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.35, "standard_charge_percentage": 35.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.75, "standard_charge_percentage": 75.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.58, "standard_charge_percentage": 58.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.75, "standard_charge_percentage": 75.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.35, "standard_charge_percentage": 35.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.34, "standard_charge_percentage": 34.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.85, "standard_charge_percentage": 85.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.69, "standard_charge_percentage": 69.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.85, "standard_charge_percentage": 85.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.77, "standard_charge_percentage": 77.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.75, "standard_charge_percentage": 75.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.78, "standard_charge_percentage": 78.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.34, "standard_charge_percentage": 34.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.85, "standard_charge_percentage": 85.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ABACAVIR SULFATE 20 MG/ML PO SOLN", "drug_information": { "unit": "240.000000", "type": "UN" }, "code_information": [ { "code": "64980040524", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 185.34, "gross_charge": 218.05, "discounted_cash": 119.93, "setting": "both", "payers_information": [ { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.52, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 174.44, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 117.09, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.75, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 185.34, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 163.54, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 61.45, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 170.25, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 174.44, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 139.55, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 174.33, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 141.73, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 61.05, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 156.3, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 156.12, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 76.32, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 163.54, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 69.17, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 76.32, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 174.44, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 141.73, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 119.93, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 163.54, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 164.13, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 141.73, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 163.54, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.22, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 141.73, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 75.01, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 169.93, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 76.32, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 174.44, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 154.1, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 164.13, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 117.09, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 163.54, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 141.73, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 174.44, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 163.54, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 130.39, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 73.92, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 155.69, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 185.34, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.22, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 163.54, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 148.27, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 141.73, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 141.73, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 148.27, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 173.35, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 165.35, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 163.54, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 163.54, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 89.62, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 76.32, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 76.32, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 76.32, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 119.93, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 141.73, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.22, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 119.93, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.22, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 54.51, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 185.34, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 163.54, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 102.48, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 128.21, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 185.34, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 126.47, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 141.73, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 167.55, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 115.57, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 174.44, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 145.31, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.64, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 180.98, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ABACAVIR SULFATE 300 MG PO TABS", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "68084002121", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 7.69, "gross_charge": 9.05, "discounted_cash": 4.98, "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.55, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.07, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.24, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.79, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.24, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.88, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.53, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.49, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.48, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.17, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.79, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.87, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.17, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.24, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.88, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.98, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.79, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.81, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.88, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.79, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.26, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.69, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.24, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.79, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.25, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.32, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.69, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.25, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.88, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.95, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.8, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.24, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.03, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.15, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.88, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.88, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.15, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.19, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.86, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.79, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.79, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.72, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.17, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.17, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.17, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.98, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.88, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.62, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.98, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.62, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.51, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.21, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": 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"standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.69, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.79, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.79, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.88, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.24, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.79, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.41, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.07, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.46, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.69, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.62, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.79, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.62, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.88, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.11, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.05, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.17, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.24, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.81, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.86, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ABACAVIR SULFATE-LAMIVUDINE 600-300 MG PO TABS", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "65862033530", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 3.4, "gross_charge": 4.0, "discounted_cash": 2.2, "setting": "both", "payers_information": [ { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.38, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.83, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.64, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.35, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.32, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.07, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.12, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.67, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.13, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.56, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.87, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.39, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.36, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.74, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.63, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.27, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.18, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.03, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.32, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ABACAVIR-DOLUTEGRAVIR-LAMIVUD 600-50-300 MG PO TABS", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "49702023113", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 360.49, "gross_charge": 424.1, "discounted_cash": 233.26, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 288.39, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 275.67, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 275.67, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 275.67, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 288.39, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 337.16, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 321.6, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 318.08, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 290.81, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 339.28, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 227.74, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 172.61, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 360.49, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 318.08, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 318.08, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 275.67, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 339.28, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 318.08, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 253.61, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 143.77, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 302.81, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 360.49, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 169.64, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 303.66, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 148.44, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 318.08, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 134.52, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 148.44, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 339.28, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 233.26, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 318.08, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 319.22, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 275.67, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 169.64, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 275.67, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 145.89, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 330.5, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 148.44, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 339.28, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 299.71, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 319.22, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 318.08, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 174.31, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 148.44, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 148.44, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 148.44, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 233.26, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 275.67, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 169.64, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 233.26, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 169.64, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 290.93, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 318.08, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 352.0, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 106.03, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 360.49, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 318.08, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 199.33, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 249.37, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 360.49, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 245.98, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 275.67, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 325.88, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 224.77, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 339.28, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 282.62, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 119.51, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 331.14, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 339.28, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 271.42, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 296.87, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 339.07, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 275.67, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.75, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 303.99, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 318.08, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 227.74, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ABATACEPT 125 MG/ML SC SOSY", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "00003218811", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 3648.15, "gross_charge": 3868.66, "discounted_cash": 2127.76, "setting": "both", "payers_information": [ { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 47.16, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1590.02, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 43.44, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 47.78, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1354.03, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 43.44, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2514.63, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1547.46, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 60.42, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 47.16, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2901.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3288.36, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3094.93, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2901.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1818.27, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2274.77, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3288.36, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2243.82, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.74, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 2972.68, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2050.39, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3094.93, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2578.08, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3648.15, "standard_charge_percentage": 94.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1354.03, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2901.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2514.63, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3094.93, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 2901.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2313.46, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1311.48, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2762.22, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3288.36, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 47.16, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2514.63, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2901.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 43.44, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 47.16, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3094.93, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2514.63, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 122.55, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2901.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2911.94, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.74, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.0, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2901.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 2652.74, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3020.65, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.64, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 86.32, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 115.67, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3092.99, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2514.63, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 47.78, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1083.22, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.74, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2077.47, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1574.54, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3288.36, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 43.44, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All 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100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 51.79, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.74, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1330.82, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3014.85, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1354.03, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 43.44, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3094.93, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2733.98, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2911.94, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2077.47, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 43.16, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "SCAN", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.64, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, 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Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3075.58, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 2933.6, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 44.52, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2653.9, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2773.06, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 43.44, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2901.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3210.99, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "Per Service Unit Rate" } ] }, { "description": "ABATACEPT 125 MG/ML SC SOSY|DISCARDED DRUG NOT ADMINISTERED", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "00003218811_2", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 3648.15, "gross_charge": 3868.66, "discounted_cash": 2127.76, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3648.15, "standard_charge_percentage": 94.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2514.63, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2901.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 43.44, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 47.16, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3094.93, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2514.63, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 122.55, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2901.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2911.94, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.74, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.0, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 2652.74, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3020.65, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.64, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 86.32, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 115.67, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3092.99, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2514.63, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 47.78, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 43.16, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "SCAN", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.64, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2514.63, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { 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"standard_charge_dollar": 3075.58, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 2933.6, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2901.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3288.36, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3094.93, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2901.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1818.27, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", 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"fee schedule" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 2972.68, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2050.39, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", 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Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2514.63, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3094.93, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", 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}, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1547.46, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 60.42, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 43.44, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 51.79, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.74, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2708.06, 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"standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2980.28, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2582.91, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3178.97, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St 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"additional_payer_notes": "N/A", "standard_charge_dollar": 47.16, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2980.28, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3178.97, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.74, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2133.88, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1617.3, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3377.65, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 43.44, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2980.28, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 43.16, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "SCAN", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.64, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2582.91, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2582.91, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2702.12, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3159.1, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3013.26, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 44.52, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 2724.77, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3102.67, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.64, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 86.32, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 115.67, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 18753.13, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2582.91, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 47.78, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1112.64, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2848.36, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2725.97, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 43.44, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 43.44, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 51.79, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.74, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1366.96, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3096.71, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1390.8, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 43.44, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3178.97, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2808.22, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2325.02, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2133.88, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2980.28, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3377.65, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2980.28, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1867.64, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2336.54, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3377.65, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2304.75, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.74, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3053.4, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2106.07, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3178.97, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2648.08, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 47.16, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1633.19, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 43.44, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 47.78, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1390.8, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 43.44, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2582.91, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1589.48, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 60.42, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 47.16, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3298.18, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2582.91, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2980.28, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 43.44, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 47.16, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3178.97, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 122.55, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2980.28, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.74, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.0, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2980.28, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "Abd paracentesis", "code_information": [ { "code": "49082", "type": "HCPCS" } ], "standard_charges": [ { "minimum": 1132.59, "maximum": 3035.34, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "outpatient", "payers_information": [ { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2265.18, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1191.26, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1191.26, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2369.21, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1132.59, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3035.34, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1585.63, "standard_charge_percentage": 100.0, "methodology": "fee schedule" } ], "additional_generic_notes": "" } ] }, { "description": "ABIRATERONE ACETATE 250 MG PO TABS", "drug_information": { "unit": "4.000000", "type": "UN" }, "code_information": [ { "code": "60687079021", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 110.24, "gross_charge": 23.36, "discounted_cash": 12.85, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15.88, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15.18, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15.18, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15.18, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15.88, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.57, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.71, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.52, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.58, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.24, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.69, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.95, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 110.24, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15.18, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.84, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.86, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.69, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.52, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.98, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.74, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.86, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.55, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15.18, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.95, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.38, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.69, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 15.57, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.74, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 15.18, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.52, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15.18, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.69, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.52, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.97, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.92, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.67, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.68, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.86, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.34, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.52, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.34, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15.18, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.04, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.2, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.18, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.69, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.51, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.67, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.54, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.02, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.54, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.51, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.86, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.52, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.73, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.18, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.52, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.41, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.18, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.69, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.85, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.52, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15.18, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.52, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.52, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.6, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.18, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.18, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.18, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.85, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.34, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.85, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.34, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.39, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "Ablate bone tumor(s) perq", "code_information": [ { "code": "20982", "type": "HCPCS" }, { "code": "20983", "type": "HCPCS" } ], "standard_charges": [ { "minimum": 8938.53, "maximum": 44069.83, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "outpatient", "payers_information": [ { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 32887.94, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 17877.05, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 16348.58, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 9076.82, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 16443.97, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 8938.53, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16348.58, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9076.82, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 44069.83, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 23955.25, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23021.55, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 12513.94, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18983.99, "standard_charge_percentage": 100.0, "methodology": "fee schedule" } ], "additional_generic_notes": "" } ] }, { "description": "Ablate inf turbinate submuc", "code_information": [ { "code": "30802", "type": "HCPCS" } ], "standard_charges": [ { "minimum": 0.4, "maximum": 5106.59, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "outpatient", "payers_information": [ { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 22033.43, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 3451.0, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.4, "standard_charge_percentage": 40.0, "estimated_amount": 12590.53, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 22033.43, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3983.96, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 22033.43, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1905.44, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 22033.43, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3810.89, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.75, "standard_charge_percentage": 75.0, "estimated_amount": 23607.25, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 22033.43, "methodology": "percent of total billed charges" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "estimated_amount": 20459.63, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1882.11, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 22033.43, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.8, "standard_charge_percentage": 80.0, "estimated_amount": 26754.9, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1882.11, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2667.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.75, "standard_charge_percentage": 75.0, "estimated_amount": 23607.25, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "estimated_amount": 20459.63, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5106.59, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4596.8, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "Ablate inf turbinate superf", "code_information": [ { "code": "30801", "type": "HCPCS" } ], "standard_charges": [ { "minimum": 0.4, "maximum": 5106.59, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "outpatient", "payers_information": [ { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "estimated_amount": 18644.09, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5106.59, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4596.8, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.8, "standard_charge_percentage": 80.0, "estimated_amount": 24380.72, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1882.11, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2667.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1905.44, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 20078.24, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3810.89, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.75, "standard_charge_percentage": 75.0, "estimated_amount": 21512.4, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 20078.24, "methodology": "percent of total billed charges" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "estimated_amount": 18644.09, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1882.11, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 20078.24, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3983.96, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 20078.24, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 20078.24, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.75, "standard_charge_percentage": 75.0, "estimated_amount": 21512.4, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 20078.24, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 3451.0, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.4, "standard_charge_percentage": 40.0, "estimated_amount": 11473.29, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "Ablate pulm tumor perq crybl", "code_information": [ { "code": "32994", "type": "HCPCS" } ], "standard_charges": [ { "minimum": 5167.69, "maximum": 34468.31, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "outpatient", "payers_information": [ { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 17858.47, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 18005.83, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 14958.87, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 13228.5, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34468.31, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 25722.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12861.31, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5167.69, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 13228.5, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13228.5, "standard_charge_percentage": 100.0, "methodology": "fee schedule" } ], "additional_generic_notes": "" } ] }, { "description": "Ablate pulm tumor perq rf", "code_information": [ { "code": "32998", "type": "HCPCS" } ], "standard_charges": [ { "minimum": 5167.69, "maximum": 19320.68, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "outpatient", "payers_information": [ { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 14418.42, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 7413.14, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 19320.68, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7413.14, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 7413.14, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 7209.21, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5167.69, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 10007.74, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10092.89, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 14958.87, "standard_charge_percentage": 100.0, "methodology": "fee schedule" } ], "additional_generic_notes": "" } ] }, { "description": "Abltj mal prst8 tiss hifu", "code_information": [ { "code": "55880", "type": "HCPCS" } ], "standard_charges": [ { "minimum": 0.4, "maximum": 30847.25, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 11510.17, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 20094.9, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 24560.11, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16114.24, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 15861.73, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 3451.0, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.4, "standard_charge_percentage": 40.0, "estimated_amount": 11482.8, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 17616.99, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "estimated_amount": 16660.09, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 11749.43, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "estimated_amount": 16660.09, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11749.43, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.8, "standard_charge_percentage": 80.0, "estimated_amount": 24400.95, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 11749.43, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4505.89, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 20094.9, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30847.25, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4596.8, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "estimated_amount": 12661.19, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 17616.99, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23020.34, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 20094.9, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.75, "standard_charge_percentage": 75.0, "estimated_amount": 18573.89, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 17616.99, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.75, "standard_charge_percentage": 75.0, "estimated_amount": 18573.89, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ABOBOTULINUMTOXINA 300 UNITS IM SOLR", "drug_information": { "unit": "300.000000", "type": "UN" }, "code_information": [ { "code": "15054053006", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 9731.2, "gross_charge": 2062.0, "discounted_cash": 1134.1, "setting": "both", "payers_information": [ { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 1413.91, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1610.01, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.65, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.61, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9731.2, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1340.3, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.49, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1476.39, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 721.7, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1546.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1340.3, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1649.6, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1546.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 1233.08, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 699.02, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1206.48, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1472.27, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1752.7, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1546.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1752.7, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1649.6, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1546.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 969.14, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1212.46, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1752.7, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1195.96, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.21, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 1584.44, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1092.86, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1649.6, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.81, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "SCAN", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.65, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1340.3, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1340.3, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1402.16, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1639.29, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 1563.61, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.31, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.63, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.57, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.21, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 709.33, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1606.92, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 721.7, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.63, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1649.6, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1457.22, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1206.48, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.68, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 847.48, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.63, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.49, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 721.7, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.63, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1340.3, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 824.8, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.33, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.68, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1402.16, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1340.3, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1546.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.63, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.68, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1649.6, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.59, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1546.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.21, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.74, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 1414.53, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.63, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 577.36, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1478.04, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.22, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 1107.29, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 839.23, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1752.7, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.63, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1546.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1546.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1443.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 1374.12, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1711.46, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1107.29, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.68, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1546.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ABOBOTULINUMTOXINA 500 UNITS IM SOLR", "drug_information": { "unit": "500.000000", "type": "UN" }, "code_information": [ { "code": "15054050001", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 16215.51, "gross_charge": 3436.0, "discounted_cash": 1889.8, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2460.18, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1202.6, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2577.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2233.4, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", 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"standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2748.8, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2748.8, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2428.22, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2010.4, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2405.2, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2336.48, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2233.4, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2577.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.63, 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"plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.74, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1845.13, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2577.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2405.2, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.81, "standard_charge_percentage": 100.0, "methodology": 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"plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2405.2, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2731.62, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 2605.52, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2405.2, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.31, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2357.1, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.63, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.68, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2405.2, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2405.2, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2405.2, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2405.2, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2405.2, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1412.2, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.63, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.49, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1202.6, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.63, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2233.4, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1374.4, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.33, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.68, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2851.88, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2405.2, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2405.2, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2405.2, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.22, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2405.2, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2405.2, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 1845.13, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1398.45, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2920.6, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2405.2, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.63, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2405.2, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2405.2, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2577.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2405.2, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2577.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2405.2, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2920.6, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2577.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1614.92, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2020.37, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2920.6, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2405.2, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1992.88, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.21, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2405.2, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2405.2, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 2640.22, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1821.08, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2748.8, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2289.75, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 2356.07, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2405.2, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2682.83, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2405.2, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.65, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2405.2, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.61, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2405.2, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2405.2, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2405.2, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16215.51, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2233.4, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.49, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 962.08, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2462.92, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "Abortion", "code_information": [ { "code": "59840", "type": "HCPCS" }, { "code": "59841", "type": "HCPCS" }, { "code": "59850", "type": "HCPCS" }, { "code": "59851", "type": "HCPCS" }, { "code": "59855", "type": "HCPCS" } ], "standard_charges": [ { "minimum": 0.339, "maximum": 10468.56, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "outpatient", "payers_information": [ { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 250.85, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 250.85, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 7674.33, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 8211.7, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 7674.33, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 7674.33, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.34, "standard_charge_percentage": 34.0, "estimated_amount": 3628.87, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 7674.33, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 7674.33, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.77, "standard_charge_percentage": 77.0, "estimated_amount": 10963.33, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 7674.33, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 14193.13, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 5278.0, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.75, "standard_charge_percentage": 75.0, "estimated_amount": 11698.5, "methodology": "percent of total billed charges" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "estimated_amount": 10138.7, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "estimated_amount": 10777.83, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.75, "standard_charge_percentage": 75.0, "estimated_amount": 12435.96, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 8114.75, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.69, "standard_charge_percentage": 69.0, "estimated_amount": 7412.29, "methodology": "percent of total billed charges" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 7674.33, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 7674.33, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.75, "standard_charge_percentage": 75.0, "estimated_amount": 4476.79, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 4039.91, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.85, "standard_charge_percentage": 85.0, "estimated_amount": 9318.84, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 7674.33, "methodology": "percent of total billed charges" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 7972.87, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.75, "standard_charge_percentage": 75.0, "estimated_amount": 8222.5, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 14193.13, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.4, "standard_charge_percentage": 40.0, "estimated_amount": 8110.36, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.8, "standard_charge_percentage": 80.0, "estimated_amount": 13258.3, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7030.4, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 11606.89, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 250.85, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 250.85, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 7674.33, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "estimated_amount": 7126.17, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 7674.33, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 7674.33, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10468.56, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.58, "standard_charge_percentage": 58.0, "estimated_amount": 6406.56, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.75, "standard_charge_percentage": 75.0, "estimated_amount": 8222.5, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7812.36, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 7674.33, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 7674.33, "methodology": "percent of total billed charges" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 7972.87, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.78, "standard_charge_percentage": 78.0, "estimated_amount": 8424.23, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 7674.33, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9883.12, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.85, "standard_charge_percentage": 85.0, "estimated_amount": 8770.66, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 7972.87, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.75, "standard_charge_percentage": 75.0, "estimated_amount": 8222.5, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.75, "standard_charge_percentage": 75.0, "estimated_amount": 9867.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 7674.33, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 7674.33, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 7972.87, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 7674.33, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 7674.33, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 8122.14, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 7674.33, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 7674.33, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3906.18, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5468.65, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 7972.87, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 7972.87, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 7674.33, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.85, "standard_charge_percentage": 85.0, "estimated_amount": 8770.66, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 7972.87, "methodology": "percent of total billed charges" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 7674.33, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 7674.33, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 7419.65, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.35, "standard_charge_percentage": 35.0, "estimated_amount": 2368.51, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4039.91, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "estimated_amount": 7126.17, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.35, "standard_charge_percentage": 35.0, "estimated_amount": 7674.33, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.85, "standard_charge_percentage": 85.0, "estimated_amount": 8569.95, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.34, "standard_charge_percentage": 34.0, "estimated_amount": 3837.17, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 7126.17, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.8, "standard_charge_percentage": 80.0, "estimated_amount": 7046.66, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "Per Service Unit Rate" } ] }, { "description": "Abortion (mpr)", "code_information": [ { "code": "59866", "type": "HCPCS" } ], "standard_charges": [ { "minimum": 386.5, "maximum": 1074.21, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "outpatient", "payers_information": [ { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1074.21, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 386.5, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 400.82, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 801.65, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 837.93, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 386.5, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.15, "standard_charge_percentage": 100.0, "methodology": "fee schedule" } ], "additional_generic_notes": "" } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [ { "code": "770", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 2175.0, "maximum": 26821.2, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 13770.01, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18777.28, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2175.0, "standard_charge_percentage": 100.0, "estimated_amount": 13685.49, "methodology": "per diem" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 13770.01, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 14685.25, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 12518.18, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 12518.18, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13221.72, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 17579.98, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12518.18, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12518.18, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12518.18, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 17943.76, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 13037.89, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 26821.2, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12518.18, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11332.91, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 12518.18, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5380.92, "standard_charge_percentage": 100.0, "estimated_amount": 5949.74, "methodology": "per diem" } ], "additional_generic_notes": "" } ] }, { "description": "ABORTION WITHOUT D&C", "code_information": [ { "code": "779", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 2175.0, "maximum": 23301.54, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 15342.13, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 10919.74, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 10919.74, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 10919.74, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12011.72, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 15589.06, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12011.72, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 10919.74, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9845.72, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10919.74, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5380.92, "standard_charge_percentage": 100.0, "estimated_amount": 5949.74, "methodology": "per diem" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 12758.15, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 10919.74, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 10919.74, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11486.67, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 16379.62, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2175.0, "standard_charge_percentage": 100.0, "estimated_amount": 13229.45, "methodology": "per diem" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 11326.97, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 23301.54, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "ABSORBABLE HEMOSTAT", "drug_information": { "unit": "5.000000", "type": "GR" }, "code_information": [ { "code": "82526100005", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 2627.94, "gross_charge": 556.85, "discounted_cash": 306.27, "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 156.92, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 434.79, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 445.48, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 356.38, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2627.94, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 361.95, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 155.92, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 399.15, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 378.66, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 361.95, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 361.95, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 361.95, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 378.66, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 442.7, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 422.26, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 417.64, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 361.95, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 398.7, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 194.9, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 417.64, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 176.63, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 194.9, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 445.48, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 306.27, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 417.64, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 325.81, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 361.95, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 417.64, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 417.64, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 228.87, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 194.9, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 194.9, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 194.9, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 306.27, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 222.74, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 325.81, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 306.27, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 222.74, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 462.19, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 417.64, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 361.95, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 445.48, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 417.64, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 333.0, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 188.77, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 397.59, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 473.32, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 222.74, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 417.64, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 139.21, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 473.32, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 445.48, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 417.64, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 261.72, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 327.43, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 473.32, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 322.97, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 361.95, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 427.88, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 295.13, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 445.48, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 371.08, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 222.74, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 361.95, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 191.56, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 433.95, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 194.9, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 445.48, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 393.53, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 299.03, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 381.83, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 299.03, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 226.64, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 473.32, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 417.64, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 389.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ABSORBASE EX OINT", "drug_information": { "unit": "454.000000", "type": "GR" }, "code_information": [ { "code": "46287050716", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 43.72, "gross_charge": 51.43, "discounted_cash": 28.29, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.97, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.43, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.43, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.43, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.97, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 40.89, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 39.0, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.57, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.86, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 43.72, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 41.14, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.57, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 24.17, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.24, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 43.72, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 29.83, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.43, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 39.52, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.26, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 41.14, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.27, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.82, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.57, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.31, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 41.14, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.29, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.57, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.71, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.43, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.57, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.57, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.14, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.29, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.43, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.57, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.29, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.57, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 42.69, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.27, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.62, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.93, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 43.72, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.57, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.57, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.43, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.69, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 40.08, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 41.14, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.35, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.71, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.62, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.49, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 40.16, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 41.14, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.92, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 41.12, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.43, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.4, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.87, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.57, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.43, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 41.14, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.57, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.76, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.43, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.72, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 43.72, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.57, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.57, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "Access thoracic lymph duct", "code_information": [ { "code": "38794", "type": "HCPCS" } ], "standard_charges": [ { "minimum": 0.4, "maximum": 0.8, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "outpatient", "payers_information": [ { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "estimated_amount": 53204.32, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 57296.94, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.4, "standard_charge_percentage": 40.0, "estimated_amount": 32741.1, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 57296.94, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 57296.94, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.75, "standard_charge_percentage": 75.0, "estimated_amount": 61389.6, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.75, "standard_charge_percentage": 75.0, "estimated_amount": 61389.6, "methodology": "percent of total billed charges" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "estimated_amount": 53204.32, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 57296.94, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 57296.94, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.8, "standard_charge_percentage": 80.0, "estimated_amount": 69574.86, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 57296.94, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ACD FORMULA A 0.73-2.45-2.2 GM/100ML VI SOLN", "drug_information": { "unit": "750.000000", "type": "UN" }, "code_information": [ { "code": "14537081775", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 188.77, "gross_charge": 40.0, "discounted_cash": 22.0, "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.27, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.23, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.6, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 188.77, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.2, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.64, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.69, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.0, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.4, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.0, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.8, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.52, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.0, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.2, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.74, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.2, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.66, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.76, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.17, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.27, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.4, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.48, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.44, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.0, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.0, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.43, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.48, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.28, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.0, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.92, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.56, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.56, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.0, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.2, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.2, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.8, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.33, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.2, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.67, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ACD FORMULA A 0.73-2.45-2.2 GM/100ML VI SOLN (ADULT CRRT)", "drug_information": { "unit": "750.000000", "type": "UN" }, "code_information": [ { "code": "14537081775_2", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 188.77, "gross_charge": 40.0, "discounted_cash": 22.0, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.0, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.8, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.52, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.0, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.2, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.74, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.2, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.2, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.2, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.8, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.33, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.44, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.0, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.4, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.0, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.43, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.48, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.28, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.0, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.64, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.69, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.0, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.4, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.27, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.23, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.6, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 188.77, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.2, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.92, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.56, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.56, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.0, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.76, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.17, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.27, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.48, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.2, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.67, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.66, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ACD FORMULA A 0.73-2.45-2.2 GM/100ML VI SOLN (APHERESIS)", "drug_information": { "unit": "750.000000", "type": "UN" }, "code_information": [ { "code": "14537081775_3", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 188.77, "gross_charge": 40.0, "discounted_cash": 22.0, "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.27, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.23, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.6, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 188.77, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.2, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.44, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.0, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.4, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.0, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.0, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.8, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.52, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.0, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.2, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.74, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.2, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.66, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.2, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.2, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.8, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.33, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.43, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.48, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.28, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.0, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.92, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.56, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.4, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.56, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.0, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.76, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.17, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.27, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.64, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.69, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.0, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.48, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.2, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.67, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ACD FORMULA A 0.73-2.45-2.2 GM/100ML VI SOLN (PEDS CRRT NXSTAGE)", "drug_information": { "unit": "750.000000", "type": "UN" }, "code_information": [ { "code": "14537081775_4", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 188.77, "gross_charge": 40.0, "discounted_cash": 22.0, "setting": "both", "payers_information": [ { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.44, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.0, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.4, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.0, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.43, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.48, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.28, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.0, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.64, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.69, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.0, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.4, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.2, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.2, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.8, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.33, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.76, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.17, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.27, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.27, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.23, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.6, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 188.77, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.92, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.56, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.56, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.0, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.0, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.8, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.52, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.0, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.2, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.74, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.2, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.2, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.67, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.48, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.2, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.66, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" } ], "additional_generic_notes": "" } ] }, { "description": "ACD FORMULA A 0.73-2.45-2.2 GM/100ML VI SOLN (PEDS CRRT PRISMAFLEX)", "drug_information": { "unit": "750.000000", "type": "UN" }, "code_information": [ { "code": "14537081775_5", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 188.77, "gross_charge": 40.0, "discounted_cash": 22.0, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.64, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.69, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.0, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.4, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.43, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.48, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.28, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.0, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.92, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.56, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.56, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.0, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.76, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.17, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.27, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.4, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.27, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.23, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.6, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 188.77, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.2, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.2, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.8, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.33, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.44, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.0, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.0, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.0, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.8, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.52, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.0, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.2, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.74, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.2, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.48, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.2, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.67, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.66, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.2, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ACETAMINOPHEN 10 MG/ML 0-50 ML SYRINGE", "drug_information": { "unit": "100.000000", "type": "UN" }, "code_information": [ { "code": "00264410090_2", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 519.12, "gross_charge": 110.0, "discounted_cash": 60.5, "setting": "both", "payers_information": [ { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.51, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.07, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 37.84, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 85.72, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.74, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.36, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 65.78, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 37.29, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.36, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 78.54, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 93.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.51, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 45.21, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 60.5, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 44.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.51, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.8, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.8, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.45, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 83.41, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 75.43, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.09, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 59.07, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 44.77, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 93.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.06, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 93.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 51.7, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.68, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 93.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 63.8, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 84.52, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.3, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.09, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 85.89, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.12, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.16, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 519.12, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.8, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 78.76, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.1, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.51, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 60.5, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.11, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 73.3, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 78.85, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.3, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 59.07, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "Per Service Unit Rate" } ] }, { "description": "ACETAMINOPHEN 10 MG/ML 0-50 ML SYRINGE (2 DAY MAX DURATION)", "drug_information": { "unit": "100.000000", "type": "UN" }, "code_information": [ { "code": "00264410090_3", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 519.12, "gross_charge": 110.0, "discounted_cash": 60.5, "setting": "both", "payers_information": [ { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 75.43, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.09, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 59.07, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 44.77, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 93.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 65.78, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 37.29, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.36, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 78.54, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 93.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.09, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 85.89, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.12, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.16, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 519.12, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.06, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 93.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 51.7, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.68, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 93.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 63.8, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 84.52, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.3, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 45.21, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 60.5, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 44.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.36, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 73.3, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.51, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.51, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.3, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.51, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.07, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 37.84, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 85.72, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.74, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 59.07, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 78.76, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.1, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.51, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 60.5, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.11, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.8, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.8, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.45, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 83.41, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.8, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 78.85, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ACETAMINOPHEN 10 MG/ML 50-100 ML INTRAVIA", "drug_information": { "unit": "100.000000", "type": "UN" }, "code_information": [ { "code": "00264410090_4", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 519.12, "gross_charge": 110.0, "discounted_cash": 60.5, "setting": "both", "payers_information": [ { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.51, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.07, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 37.84, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 85.72, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.74, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.36, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.09, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 85.89, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.12, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.16, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 519.12, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.8, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 45.21, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 60.5, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 44.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.51, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 78.85, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 59.07, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.3, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 65.78, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 37.29, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.36, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 78.54, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 93.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.51, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 78.76, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.1, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.51, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 60.5, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.11, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 75.43, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.09, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 59.07, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 44.77, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 93.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.8, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.8, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.45, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 83.41, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.06, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 93.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 51.7, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.68, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 93.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 63.8, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 84.52, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.3, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 73.3, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" } ], "additional_generic_notes": "Per Service Unit Rate" } ] }, { "description": "ACETAMINOPHEN 10 MG/ML 50-100 ML INTRAVIA (2 DAY MAX DURATION)", "drug_information": { "unit": "100.000000", "type": "UN" }, "code_information": [ { "code": "00264410090_5", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 519.12, "gross_charge": 110.0, "discounted_cash": 60.5, "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.09, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 85.89, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.12, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.16, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { 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"additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", 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"plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 78.54, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 93.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.8, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.8, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.45, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 83.41, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 78.76, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.1, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.51, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 60.5, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 45.21, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 60.5, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 44.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.36, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.51, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.3, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.11, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 75.43, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.09, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 59.07, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 44.77, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 93.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.06, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 93.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 51.7, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.68, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 93.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 63.8, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 84.52, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.3, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 73.3, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", 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"additional_payer_notes": "N/A", "standard_charge_dollar": 0.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 37.84, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 85.72, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": 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"methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.51, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.8, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 78.85, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "Per Service Unit Rate" } ] }, { "description": "ACETAMINOPHEN 10 MG/ML IV SOLN", "drug_information": { "unit": "100.000000", "type": "UN" }, "code_information": [ { "code": "00264410090_6", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 519.12, "gross_charge": 110.0, "discounted_cash": 60.5, "setting": "both", "payers_information": [ { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 75.43, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", 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"percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 93.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 78.76, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.1, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.51, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 60.5, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": 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"Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.8, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.8, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.45, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 83.41, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.09, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 85.89, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.12, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.16, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 519.12, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.8, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 45.21, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 60.5, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 44.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.36, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", 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"additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.07, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 37.84, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": 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charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 37.29, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 78.54, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 93.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", 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"additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 84.52, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.3, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 73.3, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" } ], "additional_generic_notes": "" } ] }, { "description": "ACETAMINOPHEN 10 MG/ML IV SOLN (2 DAY MAX DURATION)", "drug_information": { "unit": "100.000000", "type": "UN" }, "code_information": [ { "code": "00264410090_7", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 519.12, "gross_charge": 110.0, "discounted_cash": 60.5, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 78.76, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.1, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.51, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 60.5, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.36, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.11, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.06, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", 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charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.8, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.45, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 83.41, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 73.3, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 45.21, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 60.5, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 44.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.36, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.51, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.3, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.51, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 78.54, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.07, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 37.84, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 85.72, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.74, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 65.78, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 37.29, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 93.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.51, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 59.07, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 75.43, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.09, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 59.07, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 44.77, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 93.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.09, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 85.89, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.12, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.16, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 519.12, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.8, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 78.85, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ACETAMINOPHEN 10 MG/ML SYRINGE (NICU)", "drug_information": { "unit": "100.000000", "type": "UN" }, "code_information": [ { "code": "00264410090", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 188.77, "gross_charge": 40.0, "discounted_cash": 22.0, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.06, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.0, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.8, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.52, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.0, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.2, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.74, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.2, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.66, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.64, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.1, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.51, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.0, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.4, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.11, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.44, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.0, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.4, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.51, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.2, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.43, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.09, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.48, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.28, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.0, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.51, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.07, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.76, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.17, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.27, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.48, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.92, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.56, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.56, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.0, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.51, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.2, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.2, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.8, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.33, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.09, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.23, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.12, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.16, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 188.77, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.2, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.67, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ACETAMINOPHEN 120 MG RE SUPP", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "51672211502", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 3.4, "gross_charge": 4.0, "discounted_cash": 2.2, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.27, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.38, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.83, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.35, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.32, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.07, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.12, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.67, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.64, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.32, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.74, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.63, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.39, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.36, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.18, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.03, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.13, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.56, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.87, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ACETAMINOPHEN 32 MG/ML PO LIQUID", "drug_information": { "unit": "2.500000", "type": "UN" }, "code_information": [ { "code": "68094013058", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 3.4, "gross_charge": 4.0, "discounted_cash": 2.2, "setting": "inpatient", "payers_information": [ { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.27, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.87, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.38, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.83, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.67, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.18, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.03, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.13, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.56, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.32, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.35, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.32, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.07, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.12, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.39, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.36, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.64, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.74, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.63, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "Packaged/Bundled or Carrier Priced" } ] }, { "description": "ACETAMINOPHEN 325 MG PO TABS", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "50580045811", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 3.4, "gross_charge": 4.0, "discounted_cash": 2.2, "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.13, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.56, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.87, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.27, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.18, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.03, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.64, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.32, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.35, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.32, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.07, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.12, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.67, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.39, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.36, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.74, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.63, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.38, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.83, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ACETAMINOPHEN 325 MG RE SUPP", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "51672211602", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 3.4, "gross_charge": 4.0, "discounted_cash": 2.2, "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.13, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.56, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.87, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.27, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.35, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.32, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.07, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.12, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.67, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.18, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.03, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.64, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.32, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.39, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.36, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.74, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.63, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.38, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.83, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ACETAMINOPHEN 500 MG PO TABS", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "00904673061", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 3.4, "gross_charge": 4.0, "discounted_cash": 2.2, "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.13, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.56, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.87, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.35, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.32, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.07, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.12, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.67, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.64, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.32, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.27, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.18, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.03, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.74, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.63, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.39, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.36, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.38, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.83, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ACETAMINOPHEN 650 MG RE SUPP", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "45802073032", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 3.4, "gross_charge": 4.0, "discounted_cash": 2.2, "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.13, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.56, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.87, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.64, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.32, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.18, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.03, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.27, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.35, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.32, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.07, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.12, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.67, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.74, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.63, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.39, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.36, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.38, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.83, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ACETAMINOPHEN 80 MG PO CHEW", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "00904579146", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 3.4, "gross_charge": 4.0, "discounted_cash": 2.2, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.35, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.32, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.07, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.12, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.67, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.18, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.03, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.27, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.64, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.32, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.74, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.63, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.39, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.36, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.38, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.83, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.13, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.56, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.87, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ACETAMINOPHEN-CODEINE 120-12 MG/5ML PO SOLN", "drug_information": { "unit": "15.000000", "type": "UN" }, "code_information": [ { "code": "1785607901", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 11.23, "gross_charge": 13.21, "discounted_cash": 7.27, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.98, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.59, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.59, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.59, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.98, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.5, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.02, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.91, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.06, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.57, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.09, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.38, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.23, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.91, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.46, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.62, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.91, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.19, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.62, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.57, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.27, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.91, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.94, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.59, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.28, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.59, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.54, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.29, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.62, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.57, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.34, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.94, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.09, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.91, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.43, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.62, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.62, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.62, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.27, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.59, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.28, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.27, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.28, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.91, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.59, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.57, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.91, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.9, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.48, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.43, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.23, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.28, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.91, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.3, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.23, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.91, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.21, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.77, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.23, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.66, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.59, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.15, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.0, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.57, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.8, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.72, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.31, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.57, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.45, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.56, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.59, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.7, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.47, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.96, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.91, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" } ], "additional_generic_notes": "" } ] }, { "description": "ACETAMINOPHEN-CODEINE 300-30 MG PO TABS", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "00406048462", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 6.8, "gross_charge": 8.0, "discounted_cash": 4.4, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.44, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.44, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.36, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.07, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.73, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.54, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.4, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.02, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.78, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.71, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.71, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.8, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.75, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.23, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.65, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.02, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.3, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.8, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.76, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.7, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.8, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.64, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.15, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.24, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.25, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.25, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.12, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.24, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.73, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.29, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.4, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.4, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.64, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.49, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.3, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.26, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.8, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" } ], "additional_generic_notes": "" } ] }, { "description": "ACETAMINOPHEN-CODEINE 300-60 MG PO TABS", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "1310706001", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 6.8, "gross_charge": 8.0, "discounted_cash": 4.4, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.44, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.44, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.36, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.07, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.78, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.71, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.71, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.8, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.8, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.76, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.7, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.8, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.64, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.15, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.24, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.49, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.3, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.26, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.8, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.75, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.23, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.65, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.02, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.3, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.29, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.4, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.4, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.64, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.73, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.54, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.4, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.02, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All 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billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.25, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.12, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.24, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.73, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" } ], "additional_generic_notes": "" } ] }, { "description": "ACETAZOLAMIDE 100 MG/ML SYRINGE(PEDS)", "drug_information": { "unit": "5.000000", "type": "UN" }, "code_information": [ { "code": "09992019007", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 610.35, "gross_charge": 129.33, "discounted_cash": 71.13, "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.45, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 100.98, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", 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70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 610.35, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 84.06, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.21, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.33, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 109.93, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 103.46, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 97.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 60.79, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 76.05, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 109.93, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 75.01, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 84.06, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 99.38, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 68.54, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 103.46, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.94, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 84.06, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 84.06, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 84.06, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.94, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 102.82, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 98.07, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 97.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.68, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 69.45, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 52.64, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 109.93, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 97.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 97.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.15, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 45.27, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 45.27, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 45.27, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.13, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 84.06, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": 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"standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 75.67, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 84.06, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 44.49, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 100.79, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 45.27, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 103.46, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.4, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 69.45, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 92.6, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 45.27, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 97.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 41.02, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 45.27, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 103.46, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.13, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 97.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 84.06, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 97.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 84.06, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 103.46, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 97.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.34, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 43.84, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 92.34, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 109.93, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 51.73, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 97.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 86.19, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 97.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 92.7, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 107.34, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" } ], "additional_generic_notes": "" } ] }, { "description": "ACETAZOLAMIDE 250 MG PO TABS", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "50268005415", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 3.62, "gross_charge": 4.26, "discounted_cash": 2.34, "setting": "both", "payers_information": [ { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.75, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.49, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.49, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.49, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.34, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.77, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.7, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.34, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.7, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.54, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.05, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.49, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.35, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.49, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.41, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.77, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.34, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.21, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.77, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.07, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.62, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.41, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.0, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.5, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.62, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.47, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.77, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.27, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.26, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.41, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.2, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.33, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.41, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.73, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.41, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.77, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.19, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.05, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.9, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.77, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.77, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.9, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.39, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.23, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.92, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.29, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.73, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.62, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.7, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.77, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.47, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.32, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.49, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.41, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.21, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.29, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.77, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.41, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.55, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.44, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.04, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.62, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.7, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.98, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ACETAZOLAMIDE 25MG/ML ORAL SUSPENSION", "drug_information": { "unit": "10.000000", "type": "UN" }, "code_information": [ { "code": "P5167240231", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 3.45, "gross_charge": 4.06, "discounted_cash": 2.23, "setting": "both", "payers_information": [ { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.05, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.67, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.42, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.42, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.42, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.23, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.64, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.62, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.23, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.62, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.37, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.91, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.42, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.05, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.29, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.42, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.25, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.64, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.23, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.05, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.06, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.64, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.05, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.05, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.64, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.25, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.05, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.43, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.38, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.9, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.45, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.62, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.05, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.78, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.25, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.18, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.65, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.45, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.05, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.76, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.64, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.64, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.76, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.23, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.08, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.05, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.62, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.71, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.64, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.16, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.42, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.25, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.87, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.06, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.18, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.02, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.45, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.05, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.91, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.39, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.45, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.35, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.64, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.25, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.14, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.17, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.25, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.25, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.64, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.14, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.91, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" } ], "additional_generic_notes": "" } ] }, { "description": "ACETAZOLAMIDE ER 500 MG PO CP12", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "60687057821", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 6.47, "gross_charge": 7.61, "discounted_cash": 4.19, "setting": "both", "payers_information": [ { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.71, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.13, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.66, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.66, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.66, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.19, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.95, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.04, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.19, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.04, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.32, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.45, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.66, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.71, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.41, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.66, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.09, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.95, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.19, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.71, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.73, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.95, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.71, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.14, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.94, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.09, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.87, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.08, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.95, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.13, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.45, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.9, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.47, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.09, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.71, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.58, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.47, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.47, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.41, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.95, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.85, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.03, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.09, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.07, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.17, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.95, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.95, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.17, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.05, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.77, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.71, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.22, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.09, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.1, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.47, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.71, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.71, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.95, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.09, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.71, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.55, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.58, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.43, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.47, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.04, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.71, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.04, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.95, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.62, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.93, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.66, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.09, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.38, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.73, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.09, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ACETAZOLAMIDE SODIUM 500 MG IJ SOLR", "drug_information": { "unit": "5.000000", "type": "UN" }, "code_information": [ { "code": "39822019001", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 312.65, "gross_charge": 66.25, "discounted_cash": 36.44, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 45.05, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 43.06, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 43.06, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 43.06, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 45.05, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 52.67, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.24, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 49.69, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 49.69, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 43.06, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 49.69, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 39.62, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.46, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.76, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 47.3, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 56.31, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.78, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.56, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 56.31, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 49.69, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.14, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.96, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 56.31, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.43, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 42.18, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.91, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.11, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 49.69, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.23, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.19, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.19, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.19, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.44, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 43.06, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.5, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.76, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.44, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.78, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 45.43, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.58, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.96, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 56.31, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 49.69, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 49.69, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 44.15, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.67, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 51.73, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 42.4, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 312.65, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 43.06, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.55, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 47.49, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 47.44, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.19, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 49.69, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.01, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.78, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.44, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 49.69, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 42.18, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 49.69, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.78, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 42.18, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.79, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 51.63, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.19, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.82, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.38, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.58, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 54.99, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ACETIC ACID 0.25 % IR SOLN", "drug_information": { "unit": "1000.000000", "type": "UN" }, "code_information": [ { "code": "00338065604", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 188.77, "gross_charge": 40.0, "discounted_cash": 22.0, "setting": "both", "payers_information": [ { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.76, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.17, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.27, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.4, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.48, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.27, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.23, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.6, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 188.77, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.2, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.67, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.64, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.69, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.0, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.4, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.2, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.2, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.8, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.33, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.0, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.8, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.52, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.0, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.2, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.74, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.2, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.66, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.43, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.48, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.28, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.0, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.44, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.0, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.0, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.2, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.92, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.56, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.56, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.0, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ACETIC ACID 2 % OT SOLN", "drug_information": { "unit": "15.000000", "type": "UN" }, "code_information": [ { "code": "52817081615", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 34.88, "gross_charge": 41.03, "discounted_cash": 22.57, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.26, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.88, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.82, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.77, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.28, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 24.13, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.88, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.8, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.67, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.53, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.75, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.82, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.34, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 29.38, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.36, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.77, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.01, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.36, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.82, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.67, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.57, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.77, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.88, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.67, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.77, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.77, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.67, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.82, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.77, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 24.54, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.91, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 29.3, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.88, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.41, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.77, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.77, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.86, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.36, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.36, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.36, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.57, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.67, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.41, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.57, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.41, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.05, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.9, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.67, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.67, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.9, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.62, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.11, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.77, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.41, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.67, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.11, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.97, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.36, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.82, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 29.0, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.88, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.03, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.56, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.04, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.82, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.26, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.8, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.67, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.49, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 29.41, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.03, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.7, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.88, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.77, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.72, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ACETIC ACID 3 % SOLN", "drug_information": { "unit": "30.000000", "type": "UN" }, "code_information": [ { "code": "P8252005130", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 18.88, "gross_charge": 4.0, "discounted_cash": 2.2, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.18, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.03, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.13, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.56, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.88, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.87, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.27, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.34, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.35, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.32, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.07, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.12, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.67, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.64, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.34, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.32, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.39, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.36, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.74, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.63, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.38, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.83, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ACETIC ACID 5% SOLN", "drug_information": { "unit": "60.000000", "type": "UN" }, "code_information": [ { "code": "P4444075330", "type": "NDC" }, { "code": "P4444075360", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 18.88, "gross_charge": 4.0, "discounted_cash": 2.2, "setting": "both", "payers_information": [ { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.74, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.63, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.38, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.83, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.34, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.27, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.34, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.35, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.32, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.07, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.12, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.67, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.39, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.36, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.18, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.03, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.13, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.56, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.88, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.87, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.64, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.32, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ACETYLCHOLINE CHLORIDE 20 MG IO SOLR", "drug_information": { "unit": "0.500000", "type": "UN" }, "code_information": [ { "code": "24208053920", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 343.66, "gross_charge": 72.82, "discounted_cash": 40.05, "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.52, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 56.86, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.26, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.6, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 343.66, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 47.33, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.39, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 52.2, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 29.13, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 47.33, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.05, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 56.75, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.49, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.26, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.26, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 51.46, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 42.61, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 39.1, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 49.93, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 39.1, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 29.64, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 61.9, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 54.62, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 49.52, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 47.33, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 47.33, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 47.33, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 49.52, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 57.89, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 55.22, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 54.62, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 52.14, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.49, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 54.62, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.1, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.49, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.26, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 40.05, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 54.62, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 42.61, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 47.33, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 54.62, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 54.62, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 47.33, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.26, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 54.62, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 43.55, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 24.69, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 51.99, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 61.9, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 29.13, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 54.62, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 54.62, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 29.93, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.49, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.49, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.49, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 40.05, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 47.33, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 29.13, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 40.05, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 29.13, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.21, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 61.9, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 54.62, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.23, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 42.82, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 61.9, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 42.24, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 47.33, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.97, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 55.95, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.59, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.26, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.53, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 60.44, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ACETYLCHOLINE INTRACORONARY SYRINGE", "drug_information": { "unit": "12.000000", "type": "UN" }, "code_information": [ { "code": "09991000125", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 1235.75, "gross_charge": 261.85, "discounted_cash": 144.02, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 178.06, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 170.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 170.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 170.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 178.06, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 208.17, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 198.56, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 196.39, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 65.46, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 222.57, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 209.48, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 196.39, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 123.07, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 153.97, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 222.57, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 151.87, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 170.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 201.21, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 138.78, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 209.48, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 174.5, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 104.74, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 170.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.08, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 204.06, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.65, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 209.48, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 185.05, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 153.21, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 140.61, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 187.48, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.65, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 196.39, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 83.06, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.65, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 209.48, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 144.02, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 196.39, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 153.21, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 170.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 196.39, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 107.62, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.65, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.65, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.65, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 144.02, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 170.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 104.74, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 144.02, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 104.74, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 179.55, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 140.61, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 106.57, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 222.57, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 196.39, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 196.39, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 170.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 209.48, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 196.39, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 156.59, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.77, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": 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"standard_charge_dollar": 196.39, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 73.79, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 204.45, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 209.48, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 167.58, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", 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"methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 73.32, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 217.34, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 196.39, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 187.69, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ACETYLCYSTEINE 20 % IN SOLN", "drug_information": { "unit": "3.000000", "type": "UN" }, "code_information": [ { "code": "00517760425_2", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 10.24, "gross_charge": 9.34, "discounted_cash": 5.14, "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.63, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.29, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.47, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.98, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.47, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.07, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.62, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.69, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.35, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.07, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.07, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.07, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.35, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.43, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.08, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.34, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.94, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.47, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.39, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.49, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.94, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.42, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.24, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.18, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.95, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.47, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.22, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.69, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.27, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.96, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.27, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.47, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.14, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.03, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.24, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.84, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.27, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.27, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.27, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.14, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.07, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.74, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.14, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.74, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.75, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.74, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.24, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.21, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.28, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.27, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.47, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.6, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.03, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.02, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.02, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.8, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.94, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.07, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.47, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.59, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.17, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.54, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.67, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.94, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.74, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ACETYLCYSTEINE 20 % IN SOLN (INHALATION)", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "00517760425", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 10.24, "gross_charge": 4.0, "discounted_cash": 2.2, "setting": "both", "payers_information": [ { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.24, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.38, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.83, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.39, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.36, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.64, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.74, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.63, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.27, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.24, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.32, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.18, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.03, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.35, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.32, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.24, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.07, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.12, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.67, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.13, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.56, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.87, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ACETYLCYSTEINE 200 MG/ML IV SOLN", "drug_information": { "unit": "30.000000", "type": "UN" }, "code_information": [ { "code": "72611086004", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 395.38, "gross_charge": 83.78, "discounted_cash": 46.08, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 56.97, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 54.46, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - 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"methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 56.97, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 66.61, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 63.53, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 62.84, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 59.99, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 29.32, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 62.84, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.58, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.11, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 67.02, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.08, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 62.84, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 49.02, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.06, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 62.84, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 54.46, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 67.02, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 62.84, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 50.1, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.4, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 59.82, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.21, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.11, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 62.84, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.61, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 65.42, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 67.02, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.62, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 395.38, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 54.46, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.46, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.11, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.06, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.82, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 65.29, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 29.32, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 67.02, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 67.02, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 59.21, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 49.02, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 44.99, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.95, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.21, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 62.84, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 39.38, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 49.26, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.21, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.59, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.06, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.38, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 44.4, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 67.02, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 62.84, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.43, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 29.32, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 29.32, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 29.32, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.08, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 54.46, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.51, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.08, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.11, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 57.45, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 44.99, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.1, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.21, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 62.84, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 60.05, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 62.84, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 55.83, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 69.54, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ACETYLCYSTEINE OPHTHALMIC SOLN 20%", "drug_information": { "unit": "12.000000", "type": "UN" }, "code_information": [ { "code": "08252000247", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 519.12, "gross_charge": 110.0, "discounted_cash": 60.5, "setting": "outpatient", "payers_information": [ { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 65.78, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 37.29, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.36, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 78.54, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 93.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 44.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 44.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 37.84, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 85.72, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.74, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.36, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 59.07, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 75.43, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 59.07, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 44.77, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 93.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 45.21, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 60.5, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 44.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 60.5, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 44.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.0, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 85.89, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 70.4, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 519.12, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.8, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 78.85, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 78.76, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.89, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 60.5, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.8, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.8, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.45, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 83.41, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.5, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 93.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 51.7, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.68, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 93.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 63.8, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 84.52, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.3, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 73.3, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.3, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ACITRETIN 10 MG PO CAPS", "drug_information": { "unit": "3.000000", "type": "UN" }, "code_information": [ { "code": "42794008008", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 144.13, "gross_charge": 169.56, "discounted_cash": 93.26, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 121.4, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 59.35, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 127.17, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.78, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 59.35, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 135.65, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 110.21, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 93.26, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 127.17, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 127.63, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 110.21, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 127.17, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 67.82, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 110.21, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.33, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 132.14, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 59.35, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 135.65, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 135.65, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 119.83, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 127.63, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.05, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 115.3, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 110.21, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 110.21, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 115.3, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 134.8, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 128.58, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 127.17, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 42.39, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 144.13, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 127.17, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 79.69, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 99.7, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 144.13, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 98.34, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 110.21, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 130.29, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 89.87, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 135.65, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 112.99, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 110.21, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 127.17, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 69.69, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 59.35, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 59.35, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 59.35, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 93.26, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 67.82, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 93.26, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 67.82, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 140.73, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 47.78, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 132.39, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 135.65, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 108.52, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 135.56, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 110.21, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 47.48, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 121.54, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 116.27, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.05, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 69.01, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 144.13, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 127.17, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 127.17, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 110.21, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 135.65, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 127.17, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 101.4, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 57.48, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 118.69, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 121.07, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 144.13, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 67.82, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 127.17, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ACITRETIN 25 MG PO CAPS", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "42794008308", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 59.22, "gross_charge": 69.67, "discounted_cash": 38.32, "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.63, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 54.4, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 55.74, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 44.59, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 55.7, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 45.29, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.51, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 49.94, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 49.88, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 24.38, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 52.25, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.1, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 24.38, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 55.74, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 45.29, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.32, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 52.25, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 52.44, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 45.29, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 52.25, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 47.38, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 45.29, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 45.29, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 47.38, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 55.39, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 52.83, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 52.25, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 52.25, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.63, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 24.38, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 24.38, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 24.38, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.32, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 45.29, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.87, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.32, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.87, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 57.83, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.42, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 59.22, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 55.74, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 52.25, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.74, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 40.97, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 59.22, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 40.41, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 45.29, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.53, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.93, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 55.74, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.43, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 47.77, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 37.41, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.36, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 59.22, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 52.25, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.87, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 45.29, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.97, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 54.29, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 24.38, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 55.74, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 49.24, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 52.44, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 37.41, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 52.25, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 45.29, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 55.74, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 52.25, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 41.66, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.62, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 49.74, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 59.22, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.87, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 52.25, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.77, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "Acne surgery", "code_information": [ { "code": "10040", "type": "HCPCS" } ], "standard_charges": [ { "minimum": 0.339, "maximum": 0.85, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "outpatient", "payers_information": [ { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.34, "standard_charge_percentage": 34.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.85, "standard_charge_percentage": 85.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.35, "standard_charge_percentage": 35.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.69, "standard_charge_percentage": 69.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.85, "standard_charge_percentage": 85.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", 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"additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.34, "standard_charge_percentage": 34.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.85, "standard_charge_percentage": 85.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.8, "standard_charge_percentage": 80.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.75, "standard_charge_percentage": 75.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.85, "standard_charge_percentage": 85.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.75, "standard_charge_percentage": 75.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.35, "standard_charge_percentage": 35.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.78, "standard_charge_percentage": 78.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.75, "standard_charge_percentage": 75.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.58, "standard_charge_percentage": 58.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.75, "standard_charge_percentage": 75.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ACTIDOSE WITH SORBITOL 25 GM/120ML PO SUSP", "drug_information": { "unit": "120.000000", "type": "UN" }, "code_information": [ { "code": "66689020304", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 34.15, "gross_charge": 40.18, "discounted_cash": 22.1, "setting": "both", "payers_information": [ { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.07, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.12, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.82, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.31, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.06, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.14, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.14, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.4, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.24, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.58, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.05, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.15, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.14, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.88, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.63, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.15, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.3, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.12, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.87, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.3, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.14, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.78, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.14, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.12, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.14, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.14, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 24.03, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.62, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.69, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.15, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.07, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.14, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.32, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.12, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.12, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.12, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.32, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.94, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.47, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.14, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.55, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.58, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.35, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.15, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.14, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.14, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.51, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.06, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.06, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.06, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.1, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.12, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.07, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.1, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.07, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.32, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.37, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.14, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.72, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.12, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.12, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.25, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.8, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.77, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.06, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.14, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.75, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.06, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.14, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.1, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.14, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.24, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.12, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.14, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.35, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION", "code_information": [ { "code": "880", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 2175.0, "maximum": 23894.8, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 15985.96, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 11615.36, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 23894.8, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 11189.17, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10096.4, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11189.17, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5380.92, "standard_charge_percentage": 100.0, "estimated_amount": 17849.22, "methodology": "per diem" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12308.09, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 13082.97, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 11189.17, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 11189.17, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11779.12, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12308.09, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 15719.33, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 11189.17, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 11189.17, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 11189.17, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 16783.76, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2175.0, "standard_charge_percentage": 100.0, "estimated_amount": 17710.79, "methodology": "per diem" } ], "additional_generic_notes": "" } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH CC", "code_information": [ { "code": "289", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 2175.0, "maximum": 39302.04, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18186.32, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16606.5, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 18186.32, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5380.92, "standard_charge_percentage": 100.0, "estimated_amount": 41648.18, "methodology": "per diem" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 25515.46, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18186.32, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18186.32, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18186.32, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 27279.48, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2175.0, "standard_charge_percentage": 100.0, "estimated_amount": 44552.1, "methodology": "per diem" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 19104.87, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 39302.04, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 21518.8, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 18186.32, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 18186.32, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 19374.24, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 26293.62, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 20004.95, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 20004.95, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC", "code_information": [ { "code": "288", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 2175.0, "maximum": 68087.47, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 33097.59, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 68087.47, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 34385.05, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 34385.05, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 31259.13, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28769.36, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 31259.13, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5380.92, "standard_charge_percentage": 100.0, "estimated_amount": 11899.48, "methodology": "per diem" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 45551.48, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 43817.62, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 31259.13, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 31259.13, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 31259.13, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 37279.51, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 31259.13, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 31259.13, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 33564.23, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 46888.71, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2175.0, "standard_charge_percentage": 100.0, "estimated_amount": 45044.38, "methodology": "per diem" } ], "additional_generic_notes": "" } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC", "code_information": [ { "code": "290", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 2175.0, "maximum": 24403.31, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 11862.54, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 24403.31, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12562.12, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 13361.39, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 11420.1, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 11420.1, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 12029.8, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16326.16, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 16042.65, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 11420.1, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 11420.1, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 11420.1, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12562.12, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 11420.1, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10311.26, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11420.1, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5380.92, "standard_charge_percentage": 100.0, "estimated_amount": 5949.74, "methodology": "per diem" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 17130.16, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2175.0, "standard_charge_percentage": 100.0, "estimated_amount": 9435.64, "methodology": "per diem" } ], "additional_generic_notes": "" } ] }, { "description": "ACUTE LEUKEMIA WITH CC", "code_information": [ { "code": "835", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 22496.24, "maximum": 53241.09, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 24516.69, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 24516.69, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 24516.69, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 24516.69, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 24516.69, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 34378.09, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 26968.37, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 26968.37, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 36775.05, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 24516.69, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 24516.69, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "ACUTE LEUKEMIA WITH MCC", "code_information": [ { "code": "834", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 58215.96, "maximum": 137777.74, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 62908.75, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 94363.14, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 62908.75, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 62908.75, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 62908.75, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 69199.63, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 88127.63, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 69199.63, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 62908.75, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 62908.75, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 62908.75, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "ACUTE LEUKEMIA WITH OTHER PROCEDURES", "code_information": [ { "code": "850", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 97023.78, "maximum": 229622.91, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 156929.95, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 153620.96, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 97023.78, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 104619.96, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 104619.96, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 113194.35, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 146524.02, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 104619.96, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 104619.96, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 115081.96, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 111620.59, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 115081.96, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 125724.01, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 104619.96, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 104619.96, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 229622.91, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 104619.96, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "ACUTE LEUKEMIA WITHOUT CC/MCC", "code_information": [ { "code": "836", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 13383.57, "maximum": 31674.45, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 14722.27, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 22083.41, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 14722.27, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 14722.27, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 20665.73, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 16194.5, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 14722.27, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 14722.27, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 14722.27, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 16194.5, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 14722.27, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. 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PROCEDURES WITH MCC", "code_information": [ { "code": "834", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 2175.0, "maximum": 137777.74, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 75436.59, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 137777.74, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5380.92, "standard_charge_percentage": 100.0, "estimated_amount": 65447.14, "methodology": "per diem" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 58215.96, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2175.0, "standard_charge_percentage": 100.0, "estimated_amount": 109949.24, "methodology": "per diem" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 92175.24, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 66974.29, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 67918.58, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CC/MCC", "code_information": [ { "code": "836", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 2175.0, "maximum": 31674.45, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 15614.16, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2175.0, "standard_charge_percentage": 100.0, "estimated_amount": 39166.17, "methodology": "per diem" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 15397.07, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 21190.65, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 17342.51, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 31674.45, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5380.92, "standard_charge_percentage": 100.0, "estimated_amount": 17849.22, "methodology": "per diem" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13383.57, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITH CC/MCC", "code_information": [ { "code": "121", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 2175.0, "maximum": 28994.82, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 14094.49, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 28994.82, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 19397.94, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 20257.99, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2175.0, "standard_charge_percentage": 100.0, "estimated_amount": 27579.48, "methodology": "per diem" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 14855.86, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 15875.35, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 13505.32, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 13505.32, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 14293.22, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 14855.86, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 13505.32, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 12251.33, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13505.32, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5380.92, "standard_charge_percentage": 100.0, "estimated_amount": 17849.22, "methodology": "per diem" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18961.99, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 13505.32, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 13505.32, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 13505.32, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC", "code_information": [ { "code": "122", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 2175.0, "maximum": 16907.83, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 8016.06, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7144.15, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8016.06, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5380.92, "standard_charge_percentage": 100.0, "estimated_amount": 11899.48, "methodology": "per diem" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 8218.96, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 16907.83, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 8817.67, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11311.57, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 9257.44, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 8016.06, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 8016.06, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8334.84, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12024.09, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2175.0, "standard_charge_percentage": 100.0, "estimated_amount": 14306.24, "methodology": "per diem" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 8817.67, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 11276.92, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 8016.06, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 8016.06, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 8016.06, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC", "code_information": [ { "code": "281", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 2175.0, "maximum": 22977.5, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 15136.1, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 10772.58, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 10772.58, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 10772.58, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 10772.58, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9708.8, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10772.58, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5380.92, "standard_charge_percentage": 100.0, "estimated_amount": 11899.48, "methodology": "per diem" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 11169.45, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 22977.5, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 11849.84, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 15372.27, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 11849.84, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 12580.73, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 10772.58, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 10772.58, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11326.93, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 16158.87, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2175.0, "standard_charge_percentage": 100.0, "estimated_amount": 30239.53, "methodology": "per diem" } ], "additional_generic_notes": "" } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC", "code_information": [ { "code": "280", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 2175.0, "maximum": 40914.8, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 20810.63, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 20810.63, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 26540.87, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18918.75, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18918.75, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18918.75, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18918.75, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 17287.95, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 18918.75, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5380.92, "standard_charge_percentage": 100.0, "estimated_amount": 23798.96, "methodology": "per diem" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 19888.84, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 40914.8, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 28378.13, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2175.0, "standard_charge_percentage": 100.0, "estimated_amount": 54516.29, "methodology": "per diem" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 22401.83, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 18918.75, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 18918.75, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 20169.26, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 27372.58, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC", "code_information": [ { "code": "282", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 2175.0, "maximum": 18074.4, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 8545.85, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7637.07, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8545.85, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5380.92, "standard_charge_percentage": 100.0, "estimated_amount": 11899.48, "methodology": "per diem" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 9896.16, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 8545.85, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 8545.85, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8909.91, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 8786.04, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Optum", "plan_name": 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"description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC", "code_information": [ { "code": "284", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 2175.0, "maximum": 18470.74, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 12357.18, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 8725.85, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7804.54, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8725.85, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5380.92, "standard_charge_percentage": 100.0, "estimated_amount": 999999999.0, "methodology": "per diem" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 13088.78, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2175.0, "standard_charge_percentage": 100.0, "estimated_amount": 999999999.0, "methodology": "per diem" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 9598.44, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12270.64, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 8725.85, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 8725.85, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 8725.85, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 8978.7, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18470.74, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 10113.17, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 8725.85, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 8725.85, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9105.29, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 9598.44, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC", "code_information": [ { "code": "283", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 2175.0, "maximum": 48741.81, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 24720.7, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 31517.39, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 22473.36, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 22473.36, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 22473.36, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 22473.36, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 20595.13, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 22473.36, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5380.92, "standard_charge_percentage": 100.0, "estimated_amount": 35698.44, "methodology": "per diem" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 33710.05, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2175.0, "standard_charge_percentage": 100.0, "estimated_amount": 118167.31, "methodology": "per diem" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 23693.58, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 48741.81, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 26687.3, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 22473.36, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 22473.36, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 24027.64, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 32608.95, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 24720.7, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC", "code_information": [ { "code": "285", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 2175.0, "maximum": 13993.89, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9362.11, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 9424.2, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6692.7, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6692.7, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6692.7, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 7361.97, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6692.7, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5912.91, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6692.7, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5380.92, "standard_charge_percentage": 100.0, "estimated_amount": 999999999.0, "methodology": "per diem" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 7361.97, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 6802.48, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 13993.89, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 10039.06, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2175.0, "standard_charge_percentage": 100.0, "estimated_amount": 999999999.0, "methodology": "per diem" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 7661.99, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 6692.7, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 6692.7, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6898.39, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "ACYCLOVIR 200 MG PO CAPS", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "00904578961", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 3.4, "gross_charge": 4.0, "discounted_cash": 2.2, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.18, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.03, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.64, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.32, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.27, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.35, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.32, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.07, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.12, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.67, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.74, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.63, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.39, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.36, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.13, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.56, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.87, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.38, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.83, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ACYCLOVIR 200 MG/5ML PO SUSP", "drug_information": { "unit": "5.000000", "type": "UN" }, "code_information": [ { "code": "2315548551", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 3.4, "gross_charge": 4.0, "discounted_cash": 2.2, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.27, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.35, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.32, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.07, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.12, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.67, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.18, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.03, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.64, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.32, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.74, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.63, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.39, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.36, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.38, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.83, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.13, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.56, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.87, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ACYCLOVIR 400 MG PO TABS", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "50268006115", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 3.4, "gross_charge": 4.0, "discounted_cash": 2.2, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.35, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.32, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.07, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.12, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.67, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.64, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.32, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.38, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.83, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.27, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.18, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.03, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.13, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.56, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.87, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.74, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.63, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.39, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.36, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ACYCLOVIR 5 % EX OINT", "drug_information": { "unit": "15.000000", "type": "GR" }, "code_information": [ { "code": "72578008201", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 30.56, "gross_charge": 35.95, "discounted_cash": 19.77, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 24.45, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.37, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.37, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.37, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 24.45, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.58, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.26, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.96, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.56, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.76, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.96, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.9, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.14, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.56, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.85, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.37, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.62, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.05, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.76, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.96, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.74, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.58, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.96, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.4, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.58, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.76, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.77, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.96, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.06, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.37, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.96, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.96, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.78, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.58, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.58, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.58, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.77, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.37, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.38, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.77, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.38, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 29.84, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.38, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.37, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.37, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.02, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.58, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.76, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.41, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.06, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.31, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.13, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.07, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.76, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.01, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.74, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.37, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.07, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.77, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 24.65, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.31, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.63, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.56, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.96, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.96, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.37, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.76, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.96, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.5, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.19, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.67, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.56, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.38, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.96, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.17, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ACYCLOVIR 800 MG PO TABS", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "68084010901", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 3.4, "gross_charge": 4.0, "discounted_cash": 2.2, "setting": "both", "payers_information": [ { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.64, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.32, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.35, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.32, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.07, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.12, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.67, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.27, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.18, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.03, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.74, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.63, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.38, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.83, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 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"plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.39, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.36, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.13, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.56, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.87, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ACYCLOVIR SODIUM 50 MG/ML IV SOLN", "drug_information": { "unit": "20.000000", "type": "UN" }, "code_information": [ { "code": "55150015520", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 224.4, "gross_charge": 47.55, "discounted_cash": 26.15, "setting": "both", "payers_information": [ { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.51, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.36, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 37.06, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.64, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.04, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.04, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.6, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.82, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.53, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.66, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.91, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.04, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.66, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.43, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.12, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.82, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.95, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 40.42, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.51, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.89, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 40.42, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.66, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.35, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.96, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 40.42, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.58, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.54, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.2, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.04, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.05, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.64, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.66, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 15.08, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.51, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.04, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.91, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.15, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.66, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.33, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.91, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.91, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.33, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 37.8, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.06, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.66, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.61, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.53, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.35, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 40.42, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.66, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.4, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 37.13, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.04, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.43, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 224.4, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.91, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.31, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.08, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.66, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.91, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.66, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.29, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.54, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.64, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.64, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.64, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.15, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.02, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.15, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.51, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 39.47, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.66, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.69, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" } ], "additional_generic_notes": "Per Service Unit Rate" } ] }, { "description": "ADALIMUMAB 20 MG/0.2ML SC PSKT", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "00074061602", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 7994.02, "gross_charge": 9404.73, "discounted_cash": 5172.6, "setting": "both", "payers_information": [ { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7053.55, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7994.02, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7523.78, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7053.55, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 4420.22, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5529.98, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7994.02, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5454.74, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6113.07, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 7226.59, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 4984.51, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7523.78, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 6267.31, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6733.79, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3291.66, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7053.55, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6113.07, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7523.78, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 7053.55, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 5624.03, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3188.2, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6714.98, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7994.02, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3761.89, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 5050.34, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3827.73, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7994.02, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.73, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7053.55, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2351.18, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "SCAN", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 123.84, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6113.07, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6113.07, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6395.22, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7476.76, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 7131.61, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7053.55, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.73, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6113.07, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3235.23, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7329.11, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3291.66, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.73, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7523.78, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6646.32, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7078.94, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5050.34, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3761.89, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3865.34, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.73, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 100.9, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3291.66, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.73, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6113.07, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3761.89, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5172.6, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3761.89, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 6448.82, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7343.21, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 123.84, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6019.03, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7519.08, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6113.07, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 100.9, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2633.32, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6395.22, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6113.07, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7053.55, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.73, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 3291.66, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7523.78, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", 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"methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 6451.64, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.73, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6741.31, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7053.55, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", 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"methodology": "fee schedule" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7523.78, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7523.78, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6646.32, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7078.94, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", 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"methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", 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"standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6113.07, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 7226.59, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 4984.51, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7523.78, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 6267.31, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 5050.34, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3827.73, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7994.02, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.73, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7053.55, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6733.79, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3291.66, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7053.55, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6113.07, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7523.78, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 7053.55, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 5624.03, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3188.2, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6714.98, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7994.02, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3761.89, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6395.22, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6113.07, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7053.55, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.73, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 3291.66, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7523.78, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6113.07, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 5172.6, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 7053.55, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7078.94, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6113.07, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7053.55, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2351.18, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "SCAN", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 123.84, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6113.07, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6395.22, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7476.76, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 7131.61, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7053.55, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 6448.82, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7343.21, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 123.84, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6019.03, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7519.08, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6113.07, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 100.9, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2633.32, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 6451.64, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.73, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6741.31, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7805.93, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7053.55, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ADALIMUMAB 40 MG/0.8ML SC AJKT", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "00074433902", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 7994.02, "gross_charge": 9404.73, "discounted_cash": 5172.6, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6733.79, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3291.66, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7053.55, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6113.07, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7523.78, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 7053.55, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 5624.03, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3188.2, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6714.98, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7994.02, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3761.89, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7523.78, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 5050.34, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3827.73, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7994.02, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.73, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7053.55, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2351.18, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "SCAN", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 123.84, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6113.07, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6113.07, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6395.22, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7476.76, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 7131.61, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7053.55, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 6448.82, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7343.21, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 123.84, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6019.03, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7519.08, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6113.07, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 100.9, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2633.32, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.73, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6113.07, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3235.23, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7329.11, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3291.66, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.73, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7523.78, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6646.32, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7078.94, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5050.34, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6395.22, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6113.07, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7053.55, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.73, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 3291.66, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7523.78, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 5172.6, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 7053.55, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7078.94, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6113.07, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7053.55, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3761.89, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3865.34, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.73, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 100.9, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3291.66, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.73, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6113.07, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3761.89, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5172.6, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3761.89, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7053.55, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7994.02, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7053.55, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 4420.22, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5529.98, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7994.02, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5454.74, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6113.07, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 7226.59, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 4984.51, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7523.78, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 6267.31, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7805.93, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7053.55, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6741.31, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 6451.64, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.73, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ADALIMUMAB 40 MG/0.8ML SC PSKT", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "00074379902", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 7994.02, "gross_charge": 9404.73, "discounted_cash": 5172.6, "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 2609.01, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7343.21, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 7523.78, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3668.98, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4916.43, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7519.08, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6113.07, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2633.32, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7053.55, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6113.07, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7523.78, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 7053.55, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 5624.03, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3188.2, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6714.98, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7994.02, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3761.89, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7053.55, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3761.89, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2201.39, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6113.07, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3235.23, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7329.11, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3291.66, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7523.78, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7523.78, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6646.32, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7078.94, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5050.34, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6733.79, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3291.66, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7053.55, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 2930.23, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 3291.66, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7523.78, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6113.07, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 5264.99, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 7053.55, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7078.94, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6113.07, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3485.53, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7053.55, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7053.55, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3865.34, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 3291.66, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3291.66, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3291.66, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5172.6, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6113.07, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3761.89, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2568.29, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3761.89, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6741.31, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7805.93, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6395.22, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6113.07, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6113.07, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6395.22, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7476.76, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 7131.61, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1581.57, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 6451.64, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1834.49, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7994.02, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7053.55, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 4420.22, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5529.98, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7994.02, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { 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85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7053.55, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.31, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "Per Service Unit Rate" } ] }, { "description": "ADALIMUMAB 80 MG/0.8ML SC AJKT", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "00074012402", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 15988.08, "gross_charge": 18809.51, "discounted_cash": 10345.23, "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 2609.01, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13166.66, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 14686.47, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13166.66, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", 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"methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13166.66, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13166.66, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13166.66, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13166.66, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", 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"payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7655.47, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15988.08, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13166.66, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", 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charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1834.49, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13166.66, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 15988.08, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 14107.13, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", 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"percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 12226.18, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13166.66, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13166.66, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 14453.23, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 9969.04, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 15047.61, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 12534.66, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13467.61, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.33, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 14107.13, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 2930.23, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.33, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 15047.61, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13166.66, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 12226.18, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13166.66, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 5264.99, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 14107.13, "standard_charge_percentage": 75.0, 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"additional_payer_notes": "N/A", "standard_charge_dollar": 12790.47, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 12226.18, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13166.66, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13166.66, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13166.66, 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"standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1581.57, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 12903.32, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13166.66, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 14107.13, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 12226.18, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 15047.61, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13166.66, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13166.66, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 14107.13, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 11248.09, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6376.42, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13166.66, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13429.99, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15988.08, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7523.8, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 14107.13, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 14107.13, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13166.66, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "Per Service Unit Rate" } ] }, { "description": "ADALIMUMAB-ATTO 40 MG/0.8ML SC SOAJ", "drug_information": { "unit": "0.800000", "type": "UN" }, "code_information": [ { "code": "72511040001", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 3852.72, "gross_charge": 4532.61, "discounted_cash": 2492.94, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3245.35, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All 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"additional_payer_notes": "N/A", "standard_charge_dollar": 3172.83, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3172.83, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3172.83, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1862.9, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1586.41, "standard_charge_percentage": 35.0, 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"additional_payer_notes": "N/A", "standard_charge_dollar": 1813.04, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2492.94, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1813.04, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1277.29, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3172.83, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3539.06, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3172.83, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3626.09, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3172.83, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3172.83, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2900.87, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3172.83, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3172.83, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { 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"standard_charge_dollar": 1269.13, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1813.04, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3172.83, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2946.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3172.83, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1559.22, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3532.26, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1586.41, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3626.09, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3626.09, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3203.2, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3411.7, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3172.83, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2434.01, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 3108.01, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3172.83, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3172.83, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3172.83, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3172.83, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2434.01, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1844.77, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3852.72, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3172.83, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3172.83, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3172.83, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3399.46, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3172.83, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3172.83, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3399.46, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2946.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3626.09, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3172.83, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3172.83, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 3399.46, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2710.5, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1536.55, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3172.83, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3236.28, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3852.72, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1813.04, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3399.46, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3082.17, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2946.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3172.83, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3172.83, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3172.83, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2946.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3082.17, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3172.83, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3172.83, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3172.83, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3603.42, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3437.08, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3172.83, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3399.46, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1133.15, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3172.83, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3852.72, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3399.46, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2130.33, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2665.17, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3852.72, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3172.83, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2628.91, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2946.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3172.83, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3172.83, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3482.86, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2402.28, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3626.09, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3020.53, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3109.37, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3399.46, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3172.83, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3762.07, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3248.97, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ADEFOVIR DIPIVOXIL 10 MG PO TABS", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "42794000308", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 42.13, "gross_charge": 49.57, "discounted_cash": 27.26, "setting": "outpatient", "payers_information": [ { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 37.18, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.22, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 39.66, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 37.18, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 29.64, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.8, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.39, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 42.13, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.83, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 37.18, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.71, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.22, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.22, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.22, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.71, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 39.41, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 37.59, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 37.18, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.39, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 42.13, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 39.66, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 37.18, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.3, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 29.15, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 42.13, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.75, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.22, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.09, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.27, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 39.66, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.03, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.97, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.7, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 39.66, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.72, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 39.63, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.22, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.88, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.53, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.83, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.22, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.05, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.63, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.35, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 39.66, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.03, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 37.31, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.62, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 37.18, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.37, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.35, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.35, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.35, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.26, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.22, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.83, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.26, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.83, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 41.14, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.49, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.35, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 37.18, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 15.72, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.35, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 39.66, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.26, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 37.18, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 37.31, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.22, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 37.18, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.99, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.62, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.17, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 42.13, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 37.18, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.7, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN", "drug_information": { "unit": "30.000000", "type": "UN" }, "code_information": [ { "code": "55150019301", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 2139.35, "gross_charge": 453.32, "discounted_cash": 249.33, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 308.26, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 294.66, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 317.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 294.66, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 317.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 317.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 294.66, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 308.26, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 317.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 317.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 317.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 360.39, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 343.75, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 317.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 127.75, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 317.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 353.95, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 317.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 362.66, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 317.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 317.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 290.12, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 317.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 317.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 317.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2139.35, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 294.66, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 126.93, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 324.58, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 158.66, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 339.99, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 143.79, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.0, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 362.66, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 317.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 317.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 249.33, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 339.99, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 265.24, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.9, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 317.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 339.99, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 317.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 317.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 317.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 317.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 317.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 186.31, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 158.66, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 158.66, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 158.66, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 249.33, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 294.66, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 181.33, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 265.24, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 249.33, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.0, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 113.33, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 317.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 385.32, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 362.66, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 339.99, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 213.06, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 266.55, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 385.32, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 317.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 262.93, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.9, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 317.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 317.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 348.33, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 240.26, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 362.66, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 317.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 339.99, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical 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"standard_charge_dollar": 339.99, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 271.09, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 153.68, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 317.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 323.67, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California 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total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 184.5, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 385.32, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 317.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": 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}, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 302.09, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 324.94, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 339.99, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 317.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 376.26, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 339.99, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 310.98, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 339.99, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.0, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 317.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.9, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 317.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 155.94, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 353.27, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 158.66, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 362.66, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 320.36, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 317.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 243.43, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ADENOSINE 6 MG/2ML IV SOLN", "drug_information": { "unit": "2.000000", "type": "UN" }, "code_information": [ { "code": "67457085502", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 188.77, "gross_charge": 40.0, "discounted_cash": 22.0, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.0, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.8, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.52, "standard_charge_percentage": 59.0, 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Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.74, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.2, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.66, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.64, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": 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"methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.0, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.4, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.9, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.92, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.56, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.56, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.0, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.0, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.0, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.9, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.76, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.17, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.27, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.4, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.48, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.43, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.48, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.28, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.0, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.27, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.23, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.6, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 188.77, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.2, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.67, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.44, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.0, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.0, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.0, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.0, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.2, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.2, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.0, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.2, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.8, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.33, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" } ], "additional_generic_notes": "" } ] }, { "description": "Adjmt/revj ext fixj sys anes", "code_information": [ { "code": "20693", "type": "HCPCS" } ], "standard_charges": [ { "minimum": 0.4, "maximum": 23955.25, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 8938.53, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 44197.77, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 17877.05, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.75, "standard_charge_percentage": 75.0, "estimated_amount": 47011.88, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 44197.77, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "estimated_amount": 40903.61, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": 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"additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 44197.77, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18983.99, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 44197.77, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ADO-TRASTUZUMAB EMTANSINE 100 MG IV SOLR", "drug_information": { "unit": "5.000000", "type": "UN" }, "code_information": [ { "code": "50242008801", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 55650.03, "gross_charge": 11792.01, "discounted_cash": 6485.61, "setting": "outpatient", "payers_information": [ { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8254.41, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8844.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7664.81, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9433.61, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", 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"additional_payer_notes": "N/A", "standard_charge_dollar": 4127.2, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8844.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 3740.43, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 4127.2, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9433.61, 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"payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8254.41, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10023.21, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9433.61, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8844.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", 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of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7664.81, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8254.41, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8254.41, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 9060.98, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6249.77, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9433.61, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 8085.78, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8254.41, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8254.41, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8254.41, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8254.41, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 6332.31, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4799.35, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10023.21, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8254.41, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8254.41, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8254.41, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8844.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8018.57, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7664.81, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8254.41, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8254.41, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8254.41, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7664.81, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8018.57, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8254.41, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8254.41, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8254.41, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9374.65, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 8941.88, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8254.41, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4716.8, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8254.41, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7664.81, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8254.41, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4056.45, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9189.51, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4127.2, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9433.61, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8333.41, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6899.51, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8254.41, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6332.31, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8844.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8844.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8254.41, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8254.41, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8254.41, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8254.41, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8254.41, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4846.52, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 4127.2, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 4127.2, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4127.2, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6485.61, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 7664.81, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4716.8, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6485.61, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4716.8, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9787.37, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8254.41, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 7858.2, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8844.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 8089.32, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8844.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8254.41, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8452.51, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC", "code_information": [ { "code": "614", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 2175.0, "maximum": 56808.11, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 31103.79, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 26136.65, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 26136.65, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28003.99, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 28750.32, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 36646.05, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 26136.65, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 26136.65, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 26136.65, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 27614.64, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 56808.11, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 26136.65, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 24003.43, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 26136.65, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5380.92, "standard_charge_percentage": 100.0, "estimated_amount": 17849.22, "methodology": "per diem" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 28750.32, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38005.42, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 39204.98, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2175.0, "standard_charge_percentage": 100.0, "estimated_amount": 53834.68, "methodology": "per diem" } ], "additional_generic_notes": "" } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC", "code_information": [ { "code": "615", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 2175.0, "maximum": 35720.06, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 24839.37, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2175.0, "standard_charge_percentage": 100.0, "estimated_amount": 34457.65, "methodology": "per diem" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18215.54, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 19557.58, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 16559.57, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 16559.57, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 17608.47, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 16559.57, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 15092.99, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16559.57, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5380.92, "standard_charge_percentage": 100.0, "estimated_amount": 5949.74, "methodology": "per diem" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 17363.66, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 35720.06, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18215.54, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 23237.99, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 16559.57, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 16559.57, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 16559.57, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23897.22, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "Adult BMT Autologous Transplant", "code_information": [ { "code": "017-A", "type": "DRG" }, { "code": "016-A", "type": "DRG" } ], "standard_charges": [ { "minimum": 255999.0, "maximum": 255999.0, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 255999.0, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "ADULT TPN FEE (RX USE ONLY)", "drug_information": { "unit": "2000.000000", "type": "UN" }, "code_information": [ { "code": "9997088301", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 4483.34, "gross_charge": 950.0, "discounted_cash": 522.5, "setting": "both", "payers_information": [ { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 651.42, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 760.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 510.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 386.65, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 807.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 712.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 680.2, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 332.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 712.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 301.34, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 332.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 760.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 617.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 522.5, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 712.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 555.85, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 617.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 712.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 712.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 390.45, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 332.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 332.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 332.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 522.5, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 617.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 380.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 555.85, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 522.5, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 380.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 788.5, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 237.5, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 807.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 712.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 446.5, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 558.6, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 807.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 551.0, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 617.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 729.98, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 503.5, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 760.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 633.08, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 267.71, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 741.76, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 760.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 608.0, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4483.34, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 617.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 266.0, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 680.96, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 646.0, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 617.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 617.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 646.0, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 755.25, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 720.39, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 712.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 712.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 617.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 760.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 712.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 568.1, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 322.05, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 678.3, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 807.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 380.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 712.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 380.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 617.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 326.8, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 740.34, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 332.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 760.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 671.37, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 510.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 665.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "AFLIBERCEPT 2 MG/0.05ML IZ SOLN", "drug_information": { "unit": "0.050000", "type": "UN" }, "code_information": [ { "code": "61755000502", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 17454.71, "gross_charge": 3698.58, "discounted_cash": 2034.22, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2648.18, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1294.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2773.94, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2404.08, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2958.86, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 2773.94, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2211.75, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1253.82, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2164.04, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2640.79, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3143.79, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2773.94, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3143.79, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2958.86, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2773.94, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1738.33, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 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"payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 2841.99, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1960.25, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2958.86, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1293.42, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 1986.14, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1505.32, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3143.79, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 821.98, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2773.94, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 2536.12, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2887.85, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1109.67, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1724.56, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2310.91, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17454.71, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2404.08, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 904.18, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1035.6, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 862.28, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "SCAN", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1109.67, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2404.08, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2404.08, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2515.03, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2940.37, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 2804.63, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 915.75, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 821.98, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1034.74, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1293.42, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1272.31, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { 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"standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2164.04, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 872.7, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1520.12, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 821.98, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 904.18, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1294.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 821.98, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2404.08, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1479.43, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1207.19, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 872.7, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2515.03, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2404.08, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2773.94, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 821.98, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 872.7, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2958.86, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2491.85, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2773.94, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1293.42, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1638.33, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3069.82, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2773.94, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2464.73, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2589.01, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2651.14, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 872.7, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2773.94, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2537.23, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 821.98, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1986.14, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "AFLIBERCEPT 2 MG/0.05ML IZ SOSY", "drug_information": { "unit": "0.050000", "type": "UN" }, "code_information": [ { "code": "61755000501", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 26192.12, "gross_charge": 5550.0, "discounted_cash": 3052.5, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3774.0, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3607.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4162.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 821.98, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 872.7, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4440.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": 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"plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3247.31, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1293.42, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1638.33, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3973.8, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1942.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4162.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3607.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4440.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 4162.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 3318.9, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1881.45, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3962.7, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4717.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4440.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1293.42, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2980.35, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2258.85, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4717.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 821.98, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4162.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 3805.64, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4333.44, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1109.67, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1724.56, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2310.91, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26192.12, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3607.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 904.18, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1554.0, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 872.7, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2281.05, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 821.98, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 904.18, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1942.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 821.98, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3607.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2220.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3247.31, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1207.19, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 872.7, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 862.28, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "SCAN", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1109.67, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3607.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3774.0, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4412.25, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 4208.57, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 915.75, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4162.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4717.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4162.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2608.5, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3263.4, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4717.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3219.0, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1293.42, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 4264.62, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2941.5, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4440.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 821.98, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1034.74, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1293.42, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1909.2, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4325.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1942.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 821.98, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4440.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3922.19, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3978.24, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4606.5, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3807.3, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 821.98, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3698.52, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2980.35, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4162.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 872.7, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4162.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "AFLIBERCEPT 8 MG/0.07ML IZ SOLN", "drug_information": { "unit": "0.070000", "type": "UN" }, "code_information": [ { "code": "61755005001", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 28129.2, "gross_charge": 5960.46, "discounted_cash": 3278.25, "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 333.7, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3874.3, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2050.4, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4644.99, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2086.16, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 333.7, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4768.37, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4768.37, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4212.26, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3487.47, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4470.35, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5066.39, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4470.35, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2801.42, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3504.75, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5066.39, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3457.07, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3874.3, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 4580.02, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3159.04, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4768.37, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4267.69, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2086.16, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4470.35, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3874.3, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4768.37, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 4470.35, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 3564.36, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2020.6, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3487.47, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4255.77, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5066.39, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4053.11, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3874.3, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4470.35, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 333.7, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 2086.16, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4768.37, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3874.3, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3278.25, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 4470.35, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3874.3, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2384.18, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2449.75, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 333.7, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 367.07, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2086.16, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 333.7, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3874.3, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2384.18, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3278.25, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2384.18, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 4087.09, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4653.93, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 450.5, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3814.69, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28129.2, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3874.3, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 367.07, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1668.93, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 3200.77, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2425.91, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5066.39, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 333.7, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4470.35, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3972.05, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2384.18, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4470.35, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4470.35, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4272.46, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4947.18, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3200.77, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1490.12, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "SCAN", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 450.5, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3874.3, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4053.11, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4738.57, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 4519.82, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4172.32, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4470.35, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 4088.88, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 333.7, "standard_charge_percentage": 100.0, "methodology": "fee schedule" } ], "additional_generic_notes": "" } ] }, { "description": "After cataract laser surgery", "code_information": [ { "code": "66821", "type": "HCPCS" } ], "standard_charges": [ { "minimum": 0.4, "maximum": 6353.0, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 726.26, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 1624.86, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1523.31, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1016.76, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.8, "standard_charge_percentage": 80.0, "estimated_amount": 1973.03, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 697.05, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 513.98, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 1349.53, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "estimated_amount": 1272.15, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 697.05, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 941.02, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 4618.25, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.4, "standard_charge_percentage": 40.0, "estimated_amount": 928.49, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.75, "standard_charge_percentage": 75.0, "estimated_amount": 1426.91, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1452.52, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 1349.53, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.75, "standard_charge_percentage": 75.0, "estimated_amount": 1426.91, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 1624.86, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1946.38, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6151.6, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "estimated_amount": 798.89, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 1349.53, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 1624.86, "methodology": "percent of total billed charges" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "estimated_amount": 1272.15, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 697.05, "standard_charge_percentage": 100.0, "methodology": "fee schedule" } ], "additional_generic_notes": "" } ] }, { "description": "AFTERCARE WITH CC/MCC", "code_information": [ { "code": "949", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 2175.0, "maximum": 26895.98, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 13807.37, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 14726.19, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 12552.15, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 12552.15, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13258.58, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 13074.24, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 26895.98, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 17627.52, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12552.15, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12552.15, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12552.15, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 17993.79, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12552.15, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11364.5, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 12552.15, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5380.92, "standard_charge_percentage": 100.0, "estimated_amount": 11899.48, "methodology": "per diem" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 13807.37, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18828.23, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2175.0, "standard_charge_percentage": 100.0, "estimated_amount": 21449.12, "methodology": "per diem" } ], "additional_generic_notes": "" } ] }, { "description": "AFTERCARE WITHOUT CC/MCC", "code_information": [ { "code": "950", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 2175.0, "maximum": 14609.58, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 9815.66, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6972.31, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6972.31, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6972.31, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 7999.09, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 6972.31, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 6972.31, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7201.9, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 10458.48, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2175.0, "standard_charge_percentage": 100.0, "estimated_amount": 10689.0, "methodology": "per diem" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9774.01, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 7669.55, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 7669.55, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 7101.77, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 14609.58, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6972.31, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6173.06, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6972.31, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5380.92, "standard_charge_percentage": 100.0, "estimated_amount": 5949.74, "methodology": "per diem" } ], "additional_generic_notes": "" } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "560", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 2175.0, "maximum": 28384.11, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 15540.98, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 13227.97, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 13227.97, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13992.16, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", 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"standard_charge_dollar": 13227.97, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11993.29, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13227.97, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5380.92, "standard_charge_percentage": 100.0, "estimated_amount": 17849.22, "methodology": "per diem" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 14550.78, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", 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"additional_payer_notes": "N/A", "standard_charge_dollar": 5380.92, "standard_charge_percentage": 100.0, "estimated_amount": 23798.96, "methodology": "per diem" } ], "additional_generic_notes": "" } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC", "code_information": [ { "code": "561", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 2175.0, "maximum": 20380.13, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 10552.29, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 11158.6, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Blue Shield", "plan_name": "Medicare 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{ "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 20380.13, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13634.59, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "AGALSIDASE BETA 35 MG IV SOLR", "drug_information": { "unit": "7.000000", "type": "UN" }, "code_information": [ { "code": "58468004001", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 105543.32, "gross_charge": 22364.19, "discounted_cash": 12300.3, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15207.65, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological 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"standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15654.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13085.29, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15654.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 15968.03, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", 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"standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8945.68, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", 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"plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 17428.41, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7827.47, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17891.35, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17891.35, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15804.77, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13085.29, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15654.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 12009.57, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16773.14, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15654.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15654.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15654.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15654.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15654.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9191.68, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 7827.47, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 7827.47, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7827.47, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 12300.3, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 14536.72, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8945.68, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 12300.3, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8945.68, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 15335.13, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15654.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15654.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15654.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15654.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 12009.57, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9102.23, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 19009.56, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15654.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15654.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15654.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16773.14, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 6302.23, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15654.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 17461.96, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15654.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 17891.35, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 15654.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 15654.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 14313.08, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 15654.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15654.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15654.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 105543.32, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 14536.72, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6261.97, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 5591.05, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15654.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 19009.56, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16773.14, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 10511.17, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13150.14, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 19009.56, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15654.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 12971.23, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 14536.72, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15654.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15654.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 17184.64, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 11853.02, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 17891.35, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16773.14, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 15341.83, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 14903.5, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 18562.28, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16773.14, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15654.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16773.14, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15654.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16030.65, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "AGALSIDASE BETA 5 MG IV SOLR", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "58468004101", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 15075.05, "gross_charge": 3194.34, "discounted_cash": 1756.89, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2172.15, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2076.32, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2076.32, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2076.32, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2172.15, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2539.5, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 2422.27, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2395.76, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2395.76, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1312.87, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1118.02, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1118.02, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1118.02, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1756.89, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2076.32, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1277.74, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1869.01, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1756.89, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1277.74, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2287.15, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1118.02, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2395.76, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1013.24, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1118.02, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2555.47, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1756.89, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2395.76, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1869.01, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2076.32, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 2190.36, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2555.47, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 1715.36, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1300.1, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2715.19, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2395.76, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1277.74, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2076.32, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1098.85, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2489.35, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1118.02, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2555.47, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2257.44, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1715.36, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2395.76, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2191.32, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2651.3, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2395.76, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2076.32, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2555.47, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 2395.76, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 1910.22, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1082.88, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2280.76, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2715.19, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1277.74, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2395.76, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 798.59, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2715.19, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2395.76, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1501.34, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1878.27, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2715.19, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1852.72, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2076.32, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 2454.53, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1693.0, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2555.47, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2128.71, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 900.17, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2494.14, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2555.47, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2044.38, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2236.04, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15075.05, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2076.32, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 894.42, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2289.7, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "AICD generator procedures", "code_information": [ { "code": "245", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 2175.0, "maximum": 125606.0, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 66695.05, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 40574.0, "standard_charge_percentage": 100.0, "estimated_amount": 109650.5, "methodology": "case rate" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 55658.03, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "County of Ventura", "plan_name": "HMO", 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"methodology": "case rate" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17500.0, "standard_charge_percentage": 100.0, "estimated_amount": 99197.84, "methodology": "case rate" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2175.0, "standard_charge_percentage": 100.0, "estimated_amount": 108110.19, "methodology": "per diem" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 19000.0, "standard_charge_percentage": 100.0, "estimated_amount": 99197.84, "methodology": "case rate" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 18600.0, "standard_charge_percentage": 100.0, "estimated_amount": 37825.0, "methodology": "case rate" }, { "payer_name": "County of Ventura", "plan_name": "HMO", 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"code": "265", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 2175.0, "maximum": 88918.77, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 88918.77, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2175.0, "standard_charge_percentage": 100.0, "estimated_amount": 84263.26, "methodology": "per diem" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5380.92, "standard_charge_percentage": 100.0, "estimated_amount": 47597.92, "methodology": "per diem" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 37571.32, "standard_charge_percentage": 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"plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 40719.61, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 44791.57, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "Air injection into abdomen", "code_information": [ { "code": "49400", "type": "HCPCS" } ], "standard_charges": [ { "minimum": 0.339, "maximum": 0.85, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "outpatient", "payers_information": [ { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 19749.31, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": 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"Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 19749.31, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 19749.31, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.75, "standard_charge_percentage": 75.0, "estimated_amount": 21159.98, "methodology": "percent of total billed charges" }, { 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"percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.34, "standard_charge_percentage": 34.0, "estimated_amount": 9338.6, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.85, "standard_charge_percentage": 85.0, "estimated_amount": 23981.3, "methodology": "percent of total billed charges" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 19749.31, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 19749.31, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.35, "standard_charge_percentage": 35.0, "estimated_amount": 19749.31, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.85, "standard_charge_percentage": 85.0, "estimated_amount": 19807.45, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 19749.31, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 19749.31, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.85, "standard_charge_percentage": 85.0, "estimated_amount": 22570.64, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 19749.31, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 18338.65, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.8, "standard_charge_percentage": 80.0, "estimated_amount": 12664.17, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 19749.31, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "estimated_amount": 18338.65, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 19749.31, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 19749.31, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.78, "standard_charge_percentage": 78.0, "estimated_amount": 21679.1, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 19768.69, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.4, "standard_charge_percentage": 40.0, "estimated_amount": 11285.3, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.75, "standard_charge_percentage": 75.0, "estimated_amount": 21159.98, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 19749.31, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 19749.31, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 19749.31, "methodology": "percent of total billed charges" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 19768.69, "methodology": "percent of total billed charges" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "estimated_amount": 18338.65, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.35, "standard_charge_percentage": 35.0, "estimated_amount": 6086.75, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 19749.31, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.85, "standard_charge_percentage": 85.0, "estimated_amount": 22570.64, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.69, "standard_charge_percentage": 69.0, "estimated_amount": 19075.02, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.75, "standard_charge_percentage": 75.0, "estimated_amount": 21159.98, "methodology": "percent of total billed charges" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 19749.31, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 19749.31, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "estimated_amount": 18338.65, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.58, "standard_charge_percentage": 58.0, "estimated_amount": 16382.41, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 19778.38, "methodology": "percent of total billed charges" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 19768.69, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 19768.69, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 19749.31, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.8, "standard_charge_percentage": 80.0, "estimated_amount": 23981.3, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 19768.69, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.34, "standard_charge_percentage": 34.0, "estimated_amount": 9874.66, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 19749.31, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "estimated_amount": 18338.65, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 19749.31, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ALBENDAZOLE 200 MG PO TABS", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "43598045202", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 10.91, "gross_charge": 12.84, "discounted_cash": 7.06, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.21, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.91, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.27, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.63, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.03, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.55, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.91, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.45, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.35, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.87, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.81, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.27, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.56, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.19, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.49, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.63, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.07, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.49, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.27, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.35, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.06, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.63, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.66, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.35, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.63, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.73, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.35, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.35, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.73, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.21, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.74, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.63, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.62, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.03, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.27, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.22, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.27, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.35, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.6, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.2, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.63, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.28, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.49, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.49, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.49, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.06, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.35, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.14, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.06, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.14, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.66, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.63, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.35, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.27, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.63, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.68, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.35, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.17, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.91, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.14, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.63, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.14, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.35, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.42, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.01, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.49, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.27, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.07, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.66, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.9, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.8, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.9, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.23, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.91, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.63, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.99, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ALBUMIN HUMAN 25 % IV SOLN (MULTI-GPI)", "drug_information": { "unit": "50.000000", "type": "UN" }, "code_information": [ { "code": "68516521609", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 1009.93, "gross_charge": 214.0, "discounted_cash": 117.7, "setting": "both", "payers_information": [ { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 146.74, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 79.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 114.92, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.1, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 181.9, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 153.22, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.9, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 84.78, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 139.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.34, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 125.21, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 79.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 100.85, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 181.9, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 100.58, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 125.83, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 181.9, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 124.12, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 79.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 164.44, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 113.42, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 63.7, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 79.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 73.62, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 166.77, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.9, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 151.23, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 125.21, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 139.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 127.97, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 72.55, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.8, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 181.9, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.95, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.9, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.9, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.9, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 117.7, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 139.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 85.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.31, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 75.49, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 167.09, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 106.16, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 142.25, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1009.93, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 139.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 59.92, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 145.52, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 139.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 139.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 145.52, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 170.13, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 162.28, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 142.61, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 177.62, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 153.4, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 52.45, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 114.92, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ALBUMIN HUMAN 25 % IV SOLN (MULTI-GPI) HRS", "drug_information": { "unit": "50.000000", "type": "UN" }, "code_information": [ { "code": "68516521609_2", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 1009.93, "gross_charge": 214.0, "discounted_cash": 117.7, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 153.22, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.9, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 84.78, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 139.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.34, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 125.21, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 79.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 100.85, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 146.74, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 79.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 114.92, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.1, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 181.9, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.95, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.9, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.9, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.9, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 117.7, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 139.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 85.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 125.21, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.31, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 75.49, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 167.09, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 106.16, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 142.25, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1009.93, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 139.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 139.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 127.97, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 72.55, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.8, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 181.9, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 181.9, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 100.58, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 125.83, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 181.9, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 124.12, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 79.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 164.44, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 113.42, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 63.7, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 79.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 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"additional_payer_notes": "N/A", "standard_charge_dollar": 151.23, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 145.52, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 139.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 139.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 145.52, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 170.13, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 162.28, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 114.92, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 52.45, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 142.61, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 177.62, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 59.92, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 153.4, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ALBUMIN HUMAN 25 % IV SOLN 50ML VIAL (BULK CHARGE)", "drug_information": { "unit": "50.000000", "type": "UN" }, "code_information": [ { "code": "68516521609_3", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 1009.93, "gross_charge": 214.0, "discounted_cash": 117.7, "setting": "both", "payers_information": [ { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 63.7, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 79.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 73.62, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 166.77, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.9, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 151.23, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 125.21, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 145.52, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 139.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 139.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - 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"percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 170.13, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 162.28, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 181.9, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 100.58, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 125.83, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 181.9, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": 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}, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 113.42, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 153.22, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.9, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 84.78, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.34, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 125.21, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 79.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 100.85, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.95, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.9, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.9, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.9, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 117.7, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 139.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 85.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.31, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 139.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 127.97, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 72.55, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.8, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 181.9, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 75.49, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 167.09, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 106.16, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 142.25, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1009.93, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 139.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 177.62, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 146.74, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 79.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 114.92, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.1, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 181.9, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 142.61, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 114.92, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 52.45, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 59.92, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 153.4, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "Per Service Unit Rate" } ] }, { "description": "ALBUMIN HUMAN 25 % IV SOLN FOR REPLACEMENT FLUIDS", "drug_information": { "unit": "50.000000", "type": "UN" }, "code_information": [ { "code": "68516521609_4", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 1009.93, "gross_charge": 214.0, "discounted_cash": 117.7, "setting": "both", "payers_information": [ { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.95, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { 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"standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 85.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 125.21, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.31, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 139.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 127.97, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 72.55, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 125.21, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.8, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 181.9, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 177.62, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 63.7, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 79.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 73.62, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 166.77, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.9, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 151.23, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 114.92, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 181.9, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 100.58, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 125.83, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 181.9, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 124.12, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 79.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 164.44, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 113.42, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 142.61, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 153.22, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.9, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 84.78, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 139.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.34, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 79.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 100.85, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 146.74, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 79.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 114.92, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.1, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 181.9, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 75.49, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 167.09, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 106.16, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 142.25, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1009.93, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 139.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 59.92, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 153.4, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 145.52, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 139.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 139.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 145.52, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 170.13, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 162.28, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 52.45, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" } ], "additional_generic_notes": "" } ] }, { "description": "ALBUMIN HUMAN 5 % IV SOLN", "drug_information": { "unit": "250.000000", "type": "UN" }, "code_information": [ { "code": "68516521804", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 1009.93, "gross_charge": 214.0, "discounted_cash": 117.7, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 153.22, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.9, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 139.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 127.97, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 72.55, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 125.21, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.8, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 181.9, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "SCAN", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.66, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 139.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 139.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 145.52, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 170.13, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 162.28, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 52.45, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 181.9, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 100.58, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 125.83, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 181.9, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 124.12, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 79.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 164.44, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 113.42, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 142.61, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 146.74, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 167.09, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.66, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 106.16, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 142.25, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1009.93, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 139.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.39, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 59.92, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 63.7, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 79.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 73.62, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 166.77, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.9, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 151.23, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 125.21, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 114.92, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 79.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 114.92, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.1, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 181.9, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": 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"standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.34, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 79.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 100.85, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 153.4, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 177.62, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ALBUMIN HUMAN 5 % IV SOLN 250 ML BOTTLE (BULK CHARGE)", "drug_information": { "unit": "250.000000", "type": "UN" }, "code_information": [ { "code": "68516521401", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 1009.93, "gross_charge": 214.0, "discounted_cash": 117.7, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 153.22, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.9, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 139.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.2, 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"additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.95, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.39, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { 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"methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.31, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "SCAN", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.66, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 139.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 145.52, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 170.13, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 162.28, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 63.7, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 79.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 73.62, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 166.77, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.9, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 151.23, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 114.92, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 181.9, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 100.58, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 125.83, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 181.9, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 124.12, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 79.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 164.44, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 113.42, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 142.61, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 79.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 114.92, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.1, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 181.9, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 146.74, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 167.09, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.66, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 106.16, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 142.25, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1009.93, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 139.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.39, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 59.92, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 153.4, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 181.9, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Cedars Sinai - RMG", 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"methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 52.45, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" } ], "additional_generic_notes": "" } ] }, { "description": "ALBUMIN HUMAN 5 % IV SOLN FOR REPLACEMENT FLUIDS", "drug_information": { "unit": "250.000000", "type": "UN" }, "code_information": [ { "code": "68516521401_2", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 1009.93, "gross_charge": 214.0, "discounted_cash": 117.7, "setting": "both", "payers_information": [ { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 146.74, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 167.09, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": 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"additional_payer_notes": "N/A", "standard_charge_dollar": 58.39, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 181.9, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 100.58, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 125.83, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 181.9, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 124.12, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 79.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 164.44, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 113.42, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 153.22, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.9, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 139.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 127.97, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 72.55, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 125.21, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.8, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 145.52, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 139.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 139.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.34, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 79.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 100.85, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 63.7, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 79.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 73.62, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 166.77, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.9, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 151.23, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 125.21, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 79.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 114.92, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.1, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 181.9, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.95, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.39, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.9, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 139.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 85.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.31, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "SCAN", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.66, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 139.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 145.52, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 170.13, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 162.28, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 177.62, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 142.61, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 114.92, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 181.9, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 52.45, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 59.92, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 153.4, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ALBUMIN HUMAN 5 % SOLN (APHERESIS DOSE)", "drug_information": { "unit": "500.000000", "type": "UN" }, "code_information": [ { "code": "68516521402", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 1179.83, "gross_charge": 250.0, "discounted_cash": 137.5, "setting": "both", "payers_information": [ { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 102.75, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.39, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 162.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 100.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 146.28, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.31, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 63.7, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 79.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 86.0, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 194.83, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 200.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 200.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 176.68, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 187.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 212.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 187.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 117.5, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 147.0, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 212.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 145.0, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 79.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 192.1, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 132.5, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 200.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "SCAN", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.66, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 162.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 179.0, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 162.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 170.0, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 198.75, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 189.58, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 52.45, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 79.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 134.25, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 101.75, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 212.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 187.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 187.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 162.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 200.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 187.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 149.5, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 84.75, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 146.28, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 178.5, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 212.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 170.0, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 162.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 187.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 200.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.34, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 187.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 79.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 100.85, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.43, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 195.2, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.66, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 106.16, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 142.25, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1179.83, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 162.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.39, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 207.5, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 187.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 166.6, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 187.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 134.25, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 70.0, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 179.2, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.5, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" } ], "additional_generic_notes": "Per Service Unit Rate" } ] }, { "description": "ALBUMIN HUMAN 5 % SOLN (APHERESIS)", "drug_information": { "unit": "500.000000", "type": "UN" }, "code_information": [ { "code": "68516521402_2", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 1179.83, "gross_charge": 250.0, "discounted_cash": 137.5, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 179.0, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 187.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 162.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 200.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 187.5, "standard_charge_percentage": 75.0, "methodology": 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"standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 178.5, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 212.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 102.75, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.39, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 162.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 100.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 146.28, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.31, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 63.7, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 79.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 86.0, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 194.83, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 200.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 200.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 176.68, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 79.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 134.25, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 101.75, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 212.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 187.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 187.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 212.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 187.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 117.5, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 147.0, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 212.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 145.0, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 79.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 192.1, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 132.5, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 200.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "SCAN", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.66, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 162.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 162.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 170.0, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 198.75, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 189.58, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 52.45, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.43, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 195.2, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.66, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 106.16, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 142.25, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1179.83, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 162.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.39, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 70.0, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 170.0, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 162.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 187.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 200.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 152.34, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 187.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 79.62, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 100.85, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 207.5, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.5, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 134.25, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 166.6, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 179.2, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 187.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 187.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 175.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU", "drug_information": { "unit": "3.000000", "type": "UN" }, "code_information": [ { "code": "60687039583", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 3.4, "gross_charge": 4.0, "discounted_cash": 2.2, "setting": "both", "payers_information": [ { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.04, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.06, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.38, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.83, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.64, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.04, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.39, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.36, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.04, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.18, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.03, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.13, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.56, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.35, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.32, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.06, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.07, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.12, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.67, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.74, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.63, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.27, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.04, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.06, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.87, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.32, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "Per Service Unit Rate" } ] }, { "description": "ALBUTEROL SULFATE (5 MG/ML) 0.5% IN NEBU", "drug_information": { "unit": "0.500000", "type": "UN" }, "code_information": [ { "code": "69374033005", "type": "NDC" }, { "code": "73177014632", "type": "NDC" }, { "code": "00487990130", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 21.25, "gross_charge": 25.0, "discounted_cash": 13.75, "setting": "both", "payers_information": [ { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.25, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.6, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.48, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.75, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.67, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.82, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.43, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.0, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.25, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.25, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.25, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.0, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.88, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.96, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.75, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.25, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.25, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.25, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.75, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.75, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.7, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.25, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.5, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.25, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.21, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.25, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.66, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.75, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.25, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.75, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.95, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.48, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.85, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.25, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.75, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.14, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.43, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.18, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.25, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.75, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.9, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.75, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.75, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.93, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.75, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": 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total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 24.0, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 29.98, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 24.38, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.71, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.14, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 15.26, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.88, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 15.41, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.13, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.13, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.13, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.63, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", 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total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.43, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.71, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, 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}, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 29.81, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.44, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", 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"payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" }, { "minimum": 0.01, "maximum": 3.4, "gross_charge": 4.0, "discounted_cash": 2.2, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.27, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA 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"standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.64, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.13, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.56, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.38, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.83, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.18, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.03, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.87, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.32, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.39, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.36, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.35, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.32, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.07, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.12, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.67, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.74, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.63, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ALBUTEROL SULFATE (5MG/ML) IN NEBU 0.5 ML VIAL (BULK CHARGE)", "drug_information": { "unit": "0.500000", "type": "UN" }, "code_information": [ { "code": "73177014632_2", "type": "NDC" }, { "code": "69374033005_2", "type": "NDC" }, { "code": "00487990130_2", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 31.88, "gross_charge": 37.5, "discounted_cash": 20.63, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.5, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 24.38, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 24.38, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 24.38, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.5, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 29.81, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.44, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 25.71, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.14, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 15.26, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.88, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 24.38, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 15.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 24.38, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.9, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 29.22, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.13, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.5, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.23, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.85, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.13, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.9, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.13, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.63, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.23, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 24.38, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.14, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.57, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 29.28, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 24.0, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 29.98, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 24.38, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.5, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.38, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.88, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.63, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.05, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.88, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.75, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 24.38, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.82, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.88, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { 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"payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.43, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.71, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.25, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.78, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.88, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 15.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" }, { "minimum": 0.01, "maximum": 21.25, "gross_charge": 25.0, "discounted_cash": 13.75, "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.05, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.52, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": 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70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.25, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.25, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All 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"methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.5, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.25, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", 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"percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.75, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.93, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.75, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.25, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.75, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.75, "standard_charge_percentage": 75.0, "methodology": "percent of total billed 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16.25, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.0, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.92, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.25, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.6, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.48, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.75, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.75, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", 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"methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.56, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": 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}, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.39, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.36, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.38, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.35, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.32, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.74, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.63, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.18, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.03, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.32, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.87, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.07, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.12, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.67, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.83, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ALBUTEROL SULFATE 2 MG PO TABS", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "68084094925", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 8.42, "gross_charge": 9.91, "discounted_cash": 5.45, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.48, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.42, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.93, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.43, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.66, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.83, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.42, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.75, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.44, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.61, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.25, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.93, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.6, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.79, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.74, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.93, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.92, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.44, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.77, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.1, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.74, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.44, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.44, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.44, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.74, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.88, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.51, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.43, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.1, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.47, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.43, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.14, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.47, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.93, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.45, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.43, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.46, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.44, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.43, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.43, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.07, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.47, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.47, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.47, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.45, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.44, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.96, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.45, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.96, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.23, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.96, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.44, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.41, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.72, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.47, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.93, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.0, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.46, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.32, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.43, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.44, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.93, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.43, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.93, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.36, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.08, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.42, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.96, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.43, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.8, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.32, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.03, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.42, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.43, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.94, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ALBUTEROL SULFATE 2.5 MG/0.5ML IN NEBU", "drug_information": { "unit": "0.500000", "type": "UN" }, "code_information": [ { "code": "00487990130_3", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 3.4, "gross_charge": 4.0, "discounted_cash": 2.2, "setting": "outpatient", "payers_information": [ { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.18, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.03, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.64, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.27, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.32, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.13, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.56, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.83, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.74, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.63, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.35, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.32, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.07, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.12, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.67, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.38, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.87, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.39, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.36, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" } ], "additional_generic_notes": "" } ] }, { "description": "ALBUTEROL SULFATE 5 MG/ML CONTINUOUS NEBULIZATION (503B)", "drug_information": { "unit": "5.000000", "type": "UN" }, "code_information": [ { "code": "69374033005_3", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 21.25, "gross_charge": 25.0, "discounted_cash": 13.75, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.0, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.25, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.25, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.25, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.0, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.88, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.96, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.9, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.75, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.75, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.93, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.75, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.75, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.75, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.82, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.25, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.14, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.43, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.18, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.25, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.75, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.75, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.25, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.75, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.95, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.48, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.85, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.25, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.25, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.6, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.48, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.75, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.67, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.82, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.75, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.28, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.75, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.75, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.75, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.75, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.25, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.75, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.25, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.25, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.75, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.75, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.7, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.25, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.5, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.25, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.21, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.25, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.43, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.75, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.75, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.66, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.75, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.05, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.52, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.0, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.99, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.25, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.0, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.92, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.75, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ALBUTEROL SULFATE 5 MG/ML CONTINUOUS NEBULIZATION MAINTENANCE", "drug_information": { "unit": "5.000000", "type": "UN" }, "code_information": [ { "code": "69374033005_4", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 21.25, "gross_charge": 25.0, "discounted_cash": 13.75, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.25, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.25, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.75, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.75, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.7, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.25, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.5, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.25, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.21, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.25, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.9, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.75, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.75, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.93, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.75, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.25, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.75, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.75, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.82, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.25, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.25, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.6, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.48, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.75, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.67, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.82, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.75, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.25, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.75, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.95, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.48, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.85, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.25, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.0, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.25, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.25, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.0, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.88, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.96, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.75, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.28, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.75, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.75, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.75, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.75, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.25, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.75, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.05, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.52, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.0, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.99, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.25, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.0, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.14, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.43, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.18, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.25, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.75, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.75, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.75, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.43, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.75, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.92, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.66, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.75, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.5, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ALBUTEROL SULFATE HFA 108 (90 BASE) 8 GM INHALER (OR BULK CHARGE)", "drug_information": { "unit": "8.000000", "type": "GR" }, "code_information": [ { "code": "00173068224", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 43.29, "gross_charge": 50.93, "discounted_cash": 28.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.47, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.83, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.15, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.83, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 40.74, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.01, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.34, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.93, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.83, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.83, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.83, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.01, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.37, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.01, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.37, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 42.27, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.37, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.52, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 39.69, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.83, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 40.74, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 40.74, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.99, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.34, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.35, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.92, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.35, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.73, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 43.29, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.63, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.63, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 40.49, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.62, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.35, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 39.77, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 40.74, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.6, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 40.72, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.26, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.51, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.73, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 43.29, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.94, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 29.95, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 43.29, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 29.54, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 39.13, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.99, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 40.74, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 40.74, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.46, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.27, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.36, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 43.29, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.37, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.94, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS", "drug_information": { "unit": "8.000000", "type": "GR" }, "code_information": [ { "code": "00173068224_2", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 43.29, "gross_charge": 50.93, "discounted_cash": 28.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.47, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.83, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.15, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.83, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 40.74, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.01, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.34, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.35, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 39.77, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 40.74, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 32.6, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 40.72, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.26, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.73, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 43.29, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 40.74, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.94, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 29.95, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 43.29, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 29.54, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 39.13, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.99, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 40.74, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.94, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 40.74, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.46, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.27, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.36, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 43.29, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.37, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.63, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.63, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 40.49, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.62, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.93, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.83, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.83, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.83, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.01, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.37, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.01, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.37, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.37, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.1, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.52, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 39.69, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.83, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 40.74, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.99, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.34, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.92, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.35, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.73, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 43.29, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.35, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 42.27, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 36.51, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.65, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY", "code_information": [ { "code": "895", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 15249.92, "maximum": 36091.47, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16728.25, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 16728.25, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 25092.38, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", 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"plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 16728.25, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 23474.14, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18401.08, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC", "code_information": [ { "code": "896", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 18756.17, "maximum": 44389.59, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", 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"additional_payer_notes": "N/A", "standard_charge_dollar": 20496.81, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 20496.81, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 20496.81, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 30745.23, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 20496.81, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 20496.81, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC", "code_information": [ { "code": "897", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 9291.72, "maximum": 21990.4, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10324.29, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 11356.72, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", 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"additional_payer_notes": "N/A", "standard_charge_dollar": 10324.29, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 10324.29, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 15486.44, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 10324.29, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA", "code_information": [ { "code": "894", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 6573.3, "maximum": 15556.8, "gross_charge": 0.01, "discounted_cash": 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"estimated_amount": 999999999.0, "methodology": "per diem" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 19760.94, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 36091.47, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5380.92, "standard_charge_percentage": 100.0, "estimated_amount": 999999999.0, "methodology": "per diem" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 17791.56, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", 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"standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 10689.62, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9291.72, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 12040.27, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 21990.4, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", 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"standard_charge_dollar": 8517.72, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 15556.8, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5380.92, "standard_charge_percentage": 100.0, "estimated_amount": 11899.48, "methodology": "per diem" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 7562.22, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2175.0, "standard_charge_percentage": 100.0, "estimated_amount": 17476.37, "methodology": "per diem" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10407.72, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6573.3, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "ALDESLEUKIN 22000000 UNITS IV SOLR", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "73776002201", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 78597.16, "gross_charge": 16654.41, "discounted_cash": 9159.93, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3943.0, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "SCAN", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 7156.7, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10825.37, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10825.37, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11325.0, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13240.26, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 12629.04, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3795.26, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 11419.93, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13909.76, "standard_charge_percentage": 84.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 7156.7, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9992.65, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10567.24, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 78597.16, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10825.37, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 5831.39, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4663.23, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15705.11, "standard_charge_percentage": 94.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5829.04, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 12490.81, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10825.37, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13323.53, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 12490.81, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 9959.34, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5645.84, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9744.5, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11891.25, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 14156.25, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 5301.26, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13911.43, "standard_charge_percentage": 84.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4731.6, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10825.37, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5729.12, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 12978.78, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5829.04, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 5301.26, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13323.53, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13323.53, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11769.67, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9744.5, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10825.37, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 12490.81, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 5301.26, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 5555.93, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13323.53, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 10413.11, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12490.81, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10825.37, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7491.7, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 12490.81, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 14156.25, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 12490.81, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 7827.57, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9792.79, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 14156.25, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9659.56, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10825.37, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 12797.25, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 8826.84, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13323.53, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 5914.5, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 8943.42, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6778.34, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 14156.25, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 5301.26, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 12490.81, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5555.93, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6844.96, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 5301.26, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 5831.39, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5829.04, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5301.26, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 10825.37, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6661.76, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5520.2, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5555.93, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 11424.93, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 5301.26, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 11098.5, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8943.42, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11937.88, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5555.93, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 12490.81, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 12490.81, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11658.09, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13823.16, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ALENDRONATE SODIUM 10 MG PO TABS", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "1671463101", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 3.4, "gross_charge": 4.0, "discounted_cash": 2.2, "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.13, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.56, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.87, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.18, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.03, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.35, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.32, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.07, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.12, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.67, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.27, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.64, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.32, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.39, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.36, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.38, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.83, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.74, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.63, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ALENDRONATE SODIUM 35 MG PO TABS", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "69097022316", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 3.4, "gross_charge": 4.0, "discounted_cash": 2.2, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.27, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.64, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.32, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.13, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.56, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.87, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.35, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.32, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.07, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.12, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.67, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.18, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.03, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.39, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.36, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.74, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.63, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.38, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.83, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ALENDRONATE SODIUM 70 MG PO TABS", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "64980034214", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 3.4, "gross_charge": 4.0, "discounted_cash": 2.2, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.18, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.03, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.64, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.32, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.27, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.38, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.83, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.39, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.36, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.35, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.32, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.07, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.12, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.67, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.13, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.56, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.87, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.74, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.63, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ALFUZOSIN HCL ER 10 MG PO TB24", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "57237011490", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 3.4, "gross_charge": 4.0, "discounted_cash": 2.2, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.35, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.32, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.07, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.12, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.67, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.64, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.32, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.18, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.03, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.13, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.56, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.87, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.27, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.39, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.36, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.38, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.83, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.74, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.63, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ALGLUCOSIDASE ALFA 50 MG IV SOLR (LUMIZYME)", "drug_information": { "unit": "10.000000", "type": "UN" }, "code_information": [ { "code": "58468016001", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 18205.74, "gross_charge": 3857.72, "discounted_cash": 2121.75, "setting": "outpatient", "payers_information": [ { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3086.18, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 295.92, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert 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"standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 201.97, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2623.25, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2507.52, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2893.29, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 201.97, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 201.53, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3086.18, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2507.52, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 565.59, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2893.29, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2257.15, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 295.92, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 374.83, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2762.13, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1350.2, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2893.29, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2507.52, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3086.18, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 2893.29, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2306.92, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1307.77, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2754.41, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 197.28, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "SCAN", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 272.66, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2507.52, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2623.25, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3066.89, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 2925.31, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 2645.24, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3012.11, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 272.66, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 394.56, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 528.71, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 18205.74, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2507.52, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 222.17, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 201.53, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1585.52, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 201.97, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 222.17, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1350.2, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 201.97, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2507.52, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1543.09, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2257.15, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 276.19, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2893.29, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3279.06, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2893.29, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1813.13, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2268.34, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3279.06, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2237.48, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 295.92, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 2964.27, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2044.59, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3086.18, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 201.97, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 236.74, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 295.92, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1327.06, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3006.32, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1350.2, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 201.97, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3086.18, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2726.25, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1080.16, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2765.21, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2893.29, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2893.29, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2700.4, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 181.42, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2646.4, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 201.97, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3279.06, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 201.53, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2893.29, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2071.6, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2570.78, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 201.53, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3201.91, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ALIROCUMAB 75 MG/ML SC SOAJ", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "61755002002", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 682.35, "gross_charge": 802.76, "discounted_cash": 441.52, "setting": "both", "payers_information": [ { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 321.1, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 521.79, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 276.15, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 625.59, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 280.97, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 642.21, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 642.21, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 567.31, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 604.24, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 431.08, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 574.78, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 280.97, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 602.07, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 254.64, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 280.97, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 642.21, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 521.79, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 441.52, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 602.07, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 604.24, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 521.79, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 602.07, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 602.07, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 329.93, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 280.97, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 280.97, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 280.97, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 441.52, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 521.79, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 321.1, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 441.52, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 321.1, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 666.29, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 602.07, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 521.79, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 642.21, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 602.07, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 480.05, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 272.14, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 573.17, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 682.35, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 321.1, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 602.07, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 226.22, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 626.8, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 642.21, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 513.77, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 641.81, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 521.79, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 224.77, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 575.42, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 545.88, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 521.79, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 521.79, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 545.88, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 638.19, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 608.73, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 602.07, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 200.69, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 682.35, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 602.07, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 377.3, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 472.02, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 682.35, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 465.6, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 521.79, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 616.84, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 425.46, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 642.21, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 534.96, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 550.69, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 550.45, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 431.08, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 326.72, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 682.35, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 602.07, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 561.93, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ALISKIREN FUMARATE 150 MG PO TABS", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "66993014130", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 8.53, "gross_charge": 10.03, "discounted_cash": 5.52, "setting": "both", "payers_information": [ { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.88, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.02, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.39, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.08, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.53, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.52, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.52, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.12, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.51, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.51, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.51, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.52, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.52, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.01, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.52, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.01, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.32, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.83, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.83, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.02, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.42, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.02, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.52, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.81, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.19, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.82, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.52, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.52, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.52, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.82, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.97, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.61, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.52, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.18, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.51, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.52, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.18, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.51, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.02, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.52, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.52, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.55, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.52, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.52, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.51, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.53, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.52, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.71, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.9, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.53, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.82, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.52, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.71, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.32, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.02, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.68, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.52, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.52, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.02, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.52, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.16, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.53, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.01, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.52, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.01, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.52, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.45, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.82, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.51, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.02, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.09, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.55, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.02, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.39, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ALISKIREN FUMARATE 300 MG PO TABS", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "49884042511", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 13.46, "gross_charge": 15.83, "discounted_cash": 8.71, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.76, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.29, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.29, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.29, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.76, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.58, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.0, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.87, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.96, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.46, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.66, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.87, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.44, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.31, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.46, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.18, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.29, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.16, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.39, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.66, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.55, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.87, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.51, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.54, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.54, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.54, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.71, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.29, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.33, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.71, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.33, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.14, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.33, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.29, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.45, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.34, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.54, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.66, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.19, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.92, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.5, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.33, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.54, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.87, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.02, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.54, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.66, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.71, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.87, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.92, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.29, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.87, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.46, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.36, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.66, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.13, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.66, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.29, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.43, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.35, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.87, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.29, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.66, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.87, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.47, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.37, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.3, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.46, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.33, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.87, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.85, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.5, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.44, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.46, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.87, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.08, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ALLERGIC REACTIONS WITH MCC", "code_information": [ { "code": "915", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 2175.0, "maximum": 43320.23, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 20011.17, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 18304.33, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 20011.17, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5380.92, "standard_charge_percentage": 100.0, "estimated_amount": 41648.18, "methodology": "per diem" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 21058.13, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 43320.23, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 23718.86, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 20011.17, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 20011.17, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 21355.04, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 28070.28, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 20011.17, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 20011.17, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 20011.17, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 30016.76, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2175.0, "standard_charge_percentage": 100.0, "estimated_amount": 101438.44, "methodology": "per diem" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28981.85, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 22012.29, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 22012.29, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "ALLERGIC REACTIONS WITHOUT MCC", "code_information": [ { "code": "916", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 2175.0, "maximum": 16553.87, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 8640.84, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 8640.84, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11074.77, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 9063.64, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 7855.31, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 7855.31, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8160.35, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 7855.31, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6994.59, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7855.31, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5380.92, "standard_charge_percentage": 100.0, "estimated_amount": 5949.74, "methodology": "per diem" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 11782.97, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2175.0, "standard_charge_percentage": 100.0, "estimated_amount": 13558.81, "methodology": "per diem" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 8046.9, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 16553.87, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 11051.87, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 7855.31, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 7855.31, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 7855.31, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "Allgrft implnt knee w/scope", "code_information": [ { "code": "29867", "type": "HCPCS" } ], "standard_charges": [ { "minimum": 0.4, "maximum": 44069.83, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "outpatient", "payers_information": [ { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 37232.87, "methodology": "percent of total billed charges" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "estimated_amount": 34573.38, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16348.58, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 37232.87, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 37447.99, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 37232.87, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 37232.87, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 13864.9, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.4, "standard_charge_percentage": 40.0, "estimated_amount": 21275.92, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "estimated_amount": 34573.38, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 44069.83, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 18468.32, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.75, "standard_charge_percentage": 75.0, "estimated_amount": 39892.36, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 16443.97, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 37232.87, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 32887.94, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.75, "standard_charge_percentage": 75.0, "estimated_amount": 39892.36, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 37232.87, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.8, "standard_charge_percentage": 80.0, "estimated_amount": 45211.32, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 16348.58, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23021.55, "standard_charge_percentage": 100.0, "methodology": "fee schedule" } ], "additional_generic_notes": "" } ] }, { "description": "Allogeneic", "code_information": [ { "code": "999-A", "type": "DRG" } ], "standard_charges": [ { "minimum": 75000.0, "maximum": 812136.0, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "HEREIU Transplant", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 121980.0, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "Allogeneic (Related Donor)", "code_information": [ { "code": "007-1-4ALLOR", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 163500.0, "maximum": 163500.0, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Gold Coast Health Plan Tranplants Medi-Cal", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 163500.0, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "Allogeneic (Unrelated Donor)", "code_information": [ { "code": "007-1-4ALLOU", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 163500.0, "maximum": 163500.0, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Gold Coast Health Plan Tranplants Medi-Cal", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 163500.0, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [ { "code": "014", "type": "MS-DRG" }, { "code": "014-M", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 2175.0, "maximum": 345051.0, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 148655.25, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 178813.37, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 148655.25, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 148655.25, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 160992.82, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 292464.0, "standard_charge_percentage": 100.0, "estimated_amount": 999999999.0, "methodology": "case rate" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 158754.51, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 222982.88, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2175.0, "standard_charge_percentage": 100.0, "estimated_amount": 322827.44, "methodology": "per diem" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 345051.0, "standard_charge_percentage": 100.0, "estimated_amount": 999999999.0, "methodology": "case rate" }, { "payer_name": "SCAN", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 200684.59, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 218490.33, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Kaiser", "plan_name": "Transplant-Pediatric", "additional_payer_notes": "N/A", "standard_charge_dollar": 345051.0, "standard_charge_percentage": 100.0, "estimated_amount": 999999999.0, "methodology": "case rate" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 326585.56, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 345051.0, "standard_charge_percentage": 100.0, "estimated_amount": 999999999.0, "methodology": "case rate" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 163520.78, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Kaiser", "plan_name": "Transplant-Adult", "additional_payer_notes": "N/A", "standard_charge_dollar": 292464.0, "standard_charge_percentage": 100.0, "estimated_amount": 999999999.0, "methodology": "case rate" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 137993.92, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 148655.25, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5380.92, "standard_charge_percentage": 100.0, "estimated_amount": 340760.0, "methodology": "per diem" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 208174.17, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 148655.25, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 148655.25, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 148655.25, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 163520.78, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 292464.0, "standard_charge_percentage": 100.0, "estimated_amount": 999999999.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "Allogeneic Bone Marrow/Stem Cell Related (Single)", "code_information": [ { "code": "999-D", "type": "DRG" }, { "code": "014", "type": "DRG" } ], "standard_charges": [ { "minimum": 75000.0, "maximum": 522628.0, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 522628.0, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Blue Cross", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 484639.0, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 522628.0, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "Allogeneic Bone Marrow/Stem Cell Related Transplant", "code_information": [ { "code": "014", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 90000.0, "maximum": 326585.56, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "HealthCare Partners Transplant", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 90000.0, "standard_charge_percentage": 100.0, "estimated_amount": 267260.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "Allogeneic Cord Blood Transplant", "code_information": [ { "code": "014-C", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 436213.0, "maximum": 753251.0, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 436213.0, "standard_charge_percentage": 100.0, "estimated_amount": 999999999.0, "methodology": "case rate" }, { "payer_name": "Kaiser", "plan_name": "Transplant-Pediatric", "additional_payer_notes": "N/A", "standard_charge_dollar": 436213.0, "standard_charge_percentage": 100.0, "estimated_amount": 999999999.0, "methodology": "case rate" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 753251.0, "standard_charge_percentage": 100.0, "estimated_amount": 999999999.0, "methodology": "case rate" }, { "payer_name": "Kaiser", "plan_name": "Transplant-Adult", "additional_payer_notes": "N/A", "standard_charge_dollar": 753251.0, "standard_charge_percentage": 100.0, "estimated_amount": 999999999.0, "methodology": "case rate" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 436213.0, "standard_charge_percentage": 100.0, "estimated_amount": 999999999.0, "methodology": "case rate" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 753251.0, "standard_charge_percentage": 100.0, "estimated_amount": 999999999.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "Allogeneic Related BMT - Adult & Pediatric", "code_information": [ { "code": "014-R", "type": "DRG" } ], "standard_charges": [ { "minimum": 274796.0, "maximum": 361932.0, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Cigna Lifesource (Transplant)", "plan_name": "HMO-PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 274796.0, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "Allogeneic Stem Cell Transplant", "code_information": [ { "code": "014-S", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 290200.0, "maximum": 337579.0, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 337579.0, "standard_charge_percentage": 100.0, "estimated_amount": 999999999.0, "methodology": "case rate" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 290200.0, "standard_charge_percentage": 100.0, "estimated_amount": 999999999.0, "methodology": "case rate" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 337579.0, "standard_charge_percentage": 100.0, "estimated_amount": 999999999.0, "methodology": "case rate" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 290200.0, "standard_charge_percentage": 100.0, "estimated_amount": 999999999.0, "methodology": "case rate" }, { "payer_name": "Kaiser", "plan_name": "Transplant-Pediatric", "additional_payer_notes": "N/A", "standard_charge_dollar": 337579.0, "standard_charge_percentage": 100.0, "estimated_amount": 999999999.0, "methodology": "case rate" }, { "payer_name": "Kaiser", "plan_name": "Transplant-Adult", "additional_payer_notes": "N/A", "standard_charge_dollar": 290200.0, "standard_charge_percentage": 100.0, "estimated_amount": 999999999.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "Allogeneic Unrelated BMT - Adult & Pediatric", "code_information": [ { "code": "014-U", "type": "DRG" } ], "standard_charges": [ { "minimum": 274796.0, "maximum": 406064.0, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Cigna Lifesource (Transplant)", "plan_name": "HMO-PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 274796.0, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "Allogeneic, Related Donor", "code_information": [ { "code": "999-A", "type": "DRG" } ], "standard_charges": [ { "minimum": 75000.0, "maximum": 812136.0, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Interlink Transplant", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 156600.0, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "Allogeneic, Unrelated Donor", "code_information": [ { "code": "999-B", "type": "DRG" } ], "standard_charges": [ { "minimum": 71155.0, "maximum": 556142.0, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Interlink Transplant", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 189000.0, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "ALLOPURINOL 0.2 MG/ML SUSPENSION", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "P0378013710", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 3.4, "gross_charge": 4.0, "discounted_cash": 2.2, "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.13, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, 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"plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.56, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.87, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.27, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.64, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.32, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.35, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.32, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.07, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.12, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.67, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.18, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.03, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.38, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.83, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.39, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.36, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.74, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.63, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ALLOPURINOL 100 MG PO TABS", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "60687067701", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 3.4, "gross_charge": 4.0, "discounted_cash": 2.2, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.27, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.74, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.63, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.13, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.56, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.87, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.39, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.36, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.18, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.03, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.35, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.32, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.07, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.12, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.67, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.64, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.32, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": 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"Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.38, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.83, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ALLOPURINOL 20 MG/ML ORAL SUSPENSION", "drug_information": { "unit": "5.000000", "type": "UN" }, "code_information": [ { "code": "P0378013701", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 3.4, "gross_charge": 4.0, "discounted_cash": 2.2, "setting": "both", "payers_information": [ { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", 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"other" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.35, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.32, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.07, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.83, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.64, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.87, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.39, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.36, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.13, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.56, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.18, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.03, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.27, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.12, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.67, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.74, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.63, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.32, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ALLOPURINOL 300 MG PO TABS", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "60687068801", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 3.4, "gross_charge": 4.0, "discounted_cash": 2.2, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.27, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.35, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.32, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.07, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.12, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.67, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.64, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.32, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.74, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.63, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.18, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.03, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.13, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.56, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.87, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.39, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.36, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.38, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.83, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ALLOPURINOL 50 MG PO TABS", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "0378013701", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 3.4, "gross_charge": 4.0, "discounted_cash": 2.2, "setting": "both", "payers_information": [ { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.64, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.32, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.27, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.35, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.32, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.07, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.12, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.67, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.18, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.03, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.74, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.63, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.39, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.36, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.38, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.83, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.13, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.56, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.87, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ALLOPURINOL SODIUM 500 MG IV SOLR", "drug_information": { "unit": "500.000000", "type": "ME" }, "code_information": [ { "code": "67457018750", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 15900.31, "gross_charge": 3369.21, "discounted_cash": 1853.07, "setting": "both", "payers_information": [ { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 2310.27, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2630.68, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.75, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.1, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.87, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15900.31, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2189.99, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.5, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 943.38, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.09, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1384.75, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.0, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.5, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1179.22, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.0, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2189.99, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1347.68, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1971.32, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.77, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.09, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2526.91, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2863.83, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2695.37, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2526.91, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1583.53, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1981.1, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2863.83, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1954.14, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.33, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 2588.9, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1785.68, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2695.37, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2291.06, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2189.99, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2526.91, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.0, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.09, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2695.37, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2189.99, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1853.07, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2526.91, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1971.32, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.33, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.55, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2412.35, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1179.22, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2526.91, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2189.99, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2695.37, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 2526.91, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2014.79, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1142.16, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2405.62, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2863.83, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.55, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "SCAN", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.75, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2189.99, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2291.06, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2678.52, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 2554.87, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2526.91, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.0, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.66, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.33, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1159.01, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2625.63, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1179.22, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.0, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2695.37, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2381.02, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.33, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 1809.27, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1371.27, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2863.83, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.0, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2526.91, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2311.28, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.0, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2245.24, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1809.27, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.09, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2526.91, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2796.44, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2415.05, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2526.91, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2358.45, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ALPHA-LIPOIC ACID 600 MG PO CAPS", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "47469004472", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 3.4, "gross_charge": 4.0, "discounted_cash": 2.2, "setting": "both", "payers_information": [ { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.64, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.32, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.88, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.35, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.32, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.07, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.12, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.67, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.13, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.56, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.87, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.72, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.18, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.03, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.27, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.2, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.39, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.36, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.86, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.4, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, 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"standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", 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"standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.38, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.12, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.4, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.83, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.15, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ALPHA1-PROTEINASE INHIBITOR 1000 MG/20ML IV SOLN", "drug_information": { "unit": "1.000000", "type": "ME" }, "code_information": [ { "code": "13533070501_2", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 519.12, "gross_charge": 110.0, "discounted_cash": 60.5, "setting": "outpatient", "payers_information": [ { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.32, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": 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"N/A", "standard_charge_dollar": 4.94, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { 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total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.88, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "SCAN", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.67, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.8, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.45, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 83.41, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.8, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.94, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.27, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.8, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.32, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.27, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.94, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.86, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.32, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 37.84, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 85.72, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, 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"standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 519.12, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.43, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.27, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 45.21, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.94, "standard_charge_percentage": 100.0, "methodology": 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"standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.83, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.27, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 93.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 51.7, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.68, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 93.5, "standard_charge_percentage": 85.0, "methodology": 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"additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 84.52, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.3, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 59.07, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { 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100.0, "methodology": "fee schedule" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.8, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 78.85, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.3, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 73.3, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ALPHA1-PROTEINASE INHIBITOR 1000 MG/20ML IV SOLN|DISCARDED DRUG NOT ADMINISTERED", "drug_information": { "unit": "1.000000", "type": "ME" }, "code_information": [ { "code": "13533070501", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 13.8, "gross_charge": 1.25, "discounted_cash": 0.69, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.9, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.44, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.94, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.81, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", 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"payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.89, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.32, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.67, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.51, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.06, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.94, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.25, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.86, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.32, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.43, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.97, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.44, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.94, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.73, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.94, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.06, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.94, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.59, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.74, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.06, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.73, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.32, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.96, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.66, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.86, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.98, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.67, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.76, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.08, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.9, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.81, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.85, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.81, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.94, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.25, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.27, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.81, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.8, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.94, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.32, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.88, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "SCAN", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.67, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.81, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.85, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.99, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.95, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.27, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.51, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.94, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.43, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.44, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.94, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.81, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.5, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.83, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.27, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.04, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.67, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.27, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.94, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.55, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.94, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.94, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.06, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.27, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.94, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.83, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.43, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.35, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.9, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ALPHA1-PROTEINASE INHIBITOR 1000 MG/50ML IV SOLN", "drug_information": { "unit": "1.000000", "type": "ME" }, "code_information": [ { "code": "00944288401_2", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 519.12, "gross_charge": 110.0, "discounted_cash": 60.5, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.8, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.8, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.45, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 83.41, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 65.78, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 37.29, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.36, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 78.54, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 93.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 44.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 78.76, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.89, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 60.5, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.5, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 93.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 51.7, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.68, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 93.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 63.8, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 84.52, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.3, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 75.43, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 59.07, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 44.77, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 93.5, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 44.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 37.84, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 85.72, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.74, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.36, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.0, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 85.89, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 88.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 70.4, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 519.12, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.8, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 59.07, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 45.21, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 60.5, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.5, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 44.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 60.5, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 44.0, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.3, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 73.3, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 77.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 78.85, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ALPHA1-PROTEINASE INHIBITOR 1000 MG/50ML IV SOLN|DISCARDED DRUG NOT ADMINISTERED", "drug_information": { "unit": "1.000000", "type": "ME" }, "code_information": [ { "code": "00944288401", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 7.55, "gross_charge": 1.6, "discounted_cash": 0.88, "setting": "outpatient", "payers_information": [ { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.04, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.09, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.27, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.21, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.04, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.75, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.94, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.36, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.93, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.04, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.23, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.85, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.28, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.07, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.56, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.28, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.04, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.94, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.04, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.1, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.28, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.96, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.54, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.14, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.36, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.64, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.45, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.28, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.02, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.55, "standard_charge_percentage": 472.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.04, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.45, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.15, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.15, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.56, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.51, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.25, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.28, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.66, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.56, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.56, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.56, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.64, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.94, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.88, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.64, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.33, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.09, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.04, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.04, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.55, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.25, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.56, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.28, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.13, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.86, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.4, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.36, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.86, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.65, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.36, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.64, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.12, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.2, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.04, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" } ], "additional_generic_notes": "" } ] }, { "description": "ALPRAZOLAM 0.25 MG PO TABS", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "60687037701", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 6.8, "gross_charge": 8.0, "discounted_cash": 4.4, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.8, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.76, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.7, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.8, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.64, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.15, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.24, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.73, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.54, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.4, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.02, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.29, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.4, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.4, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.64, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.44, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.44, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.36, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.07, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.49, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.3, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.26, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.8, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.75, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.23, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.65, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.02, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.3, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.78, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.71, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.71, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.8, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.25, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.25, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.12, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.24, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.73, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ALPRAZOLAM 0.5 MG PO TABS", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "60687038801", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 6.8, "gross_charge": 8.0, "discounted_cash": 4.4, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.44, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.44, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.36, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.07, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.29, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.4, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.4, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.64, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.73, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.54, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.4, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.02, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.8, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.76, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.7, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.8, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.64, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.15, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.24, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.25, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.25, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.12, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.24, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.73, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.49, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.3, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.26, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.8, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.75, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.23, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.65, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.02, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.3, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.78, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.71, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.71, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.8, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ALPRAZOLAM 1 MG PO TABS", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "R5976237211", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 6.8, "gross_charge": 8.0, "discounted_cash": 4.4, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.73, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.54, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.4, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.02, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Axminister Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Care Specialists - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prospect Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.29, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.4, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.4, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.64, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.8, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "HEREIU Tertiary", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "HealthCare Partners HMO", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.76, "standard_charge_percentage": 47.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.7, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation for Medical Care", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.8, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Premier Physician - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.64, "standard_charge_percentage": 58.0, "methodology": "percent of total billed charges" }, { "payer_name": "Valley Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Riverside Medical Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.15, "standard_charge_percentage": 77.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.24, "standard_charge_percentage": 53.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.33, "standard_charge_percentage": 67.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net Non B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.44, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.44, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Mary IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.36, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.07, "standard_charge_percentage": 76.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Mercy Healthcare Bakersfield_RRUCLA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seaview IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Tri Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Care - PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.75, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.23, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.65, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.02, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.3, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.25, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.25, "standard_charge_percentage": 78.0, "methodology": "percent of total billed charges" }, { "payer_name": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.12, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Huntington Park medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alamitos IPA LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "MemorialCare Medical Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.24, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.73, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.49, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group San Luis Obispo - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Family Choice Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Alliance Physicians of the High Desert Inc LOA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.3, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.26, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliated Health Fund - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.8, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Korean American Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Apple Care Medical Group St. Francis - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "San Bernardino - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Saint Johns - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Multiplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Access Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.78, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.71, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.71, "standard_charge_percentage": 71.0, "methodology": "percent of total billed charges" }, { "payer_name": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.8, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cedars Sinai - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Brookshire IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "ALPRAZOLAM 2 MG PO TABS", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "00781108901", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 6.8, "gross_charge": 8.0, "discounted_cash": 4.4, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.73, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Physicians Choice Medical Group Santa Maria - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.54, "standard_charge_percentage": 32.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Lakewood IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Torrance Hospital - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.4, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "GemCare PPO", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.02, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Santa Barbara Select IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.2, "standard_charge_percentage": 65.0, "methodology": "percent of total billed charges" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St. Jude", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.0, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Affiliate Health Fund", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.8, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "Teachers Health Trust", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.4, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { 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