{ "hospital_name": "Ronald Reagan UCLA Medical Center", "last_updated_on": "2025-03-29", "as_of_date": "2025-01-01", "version": "2.0.0", "hospital_location": [ "Ronald Reagan UCLA Medical Center" ], "hospital_address": [ "757 Westwood Plaza, Los Angeles, CA 90095 NULL" ], "license_information": { "license_number": "930000162|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": "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.48, "standard_charge_percentage": 29.0, "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": 14.09, "standard_charge_percentage": 35.0, "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": "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.4, "standard_charge_percentage": 59.0, "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "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": 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": 28.64, "standard_charge_percentage": 72.0, "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.51, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "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": "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": "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": "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.36, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.32, "standard_charge_percentage": 83.0, "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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" } ], "additional_generic_notes": "" } ] }, { "description": "2d tee w or w/o fol w/con,in", "code_information": [ { "code": "C8925", "type": "HCPCS" } ], "standard_charges": [ { "minimum": 0.4, "maximum": 0.75, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "outpatient", "payers_information": [ { "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": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Upland Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.75, "standard_charge_percentage": 75.0, "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": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Western Neurological Network - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.65, "standard_charge_percentage": 65.0, "estimated_amount": 999999999.0, "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": 999999999.0, "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": 0.75, "standard_charge_percentage": 75.0, "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": 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": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "United Family Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Joseph Heritage - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sharp Rees-Stealy - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 999999999.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.4, "standard_charge_percentage": 40.0, "estimated_amount": 999999999.0, "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": 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": "outpatient", "payers_information": [ { "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": "First Health", "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": "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 62.56, "standard_charge_percentage": 29.0, "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": 76.82, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "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": "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 164.13, "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": 174.44, "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": 54.51, "standard_charge_percentage": 25.0, "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 163.54, "standard_charge_percentage": 75.0, "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": "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" }, { "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 121.89, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 163.54, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": 141.73, "standard_charge_percentage": 65.0, "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": "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": "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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 181.64, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 68.18, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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" } ], "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.54, "standard_charge_percentage": 83.0, "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": 6.34, "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": 6.34, "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": 4.86, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.68, "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.6, "standard_charge_percentage": 29.0, "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": 3.19, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "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": "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.81, "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": 7.24, "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": 2.26, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.79, "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": "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "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" }, { "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": "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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 6.79, "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": 6.15, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.79, "standard_charge_percentage": 75.0, "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": 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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.83, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.06, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "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": "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": 7.51, "standard_charge_percentage": 83.0, "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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.33, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.24, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.25, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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 Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": 2.86, "standard_charge_percentage": 72.0, "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.15, "standard_charge_percentage": 29.0, "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": 1.41, "standard_charge_percentage": 35.0, "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "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": 3.2, "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": 1.0, "standard_charge_percentage": 25.0, "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": "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": "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": "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": "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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 121.67, "standard_charge_percentage": 29.0, "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": 149.41, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "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": "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 319.22, "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": 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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "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" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 353.28, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "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", "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 318.08, "standard_charge_percentage": 75.0, "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": 296.87, "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": 318.08, "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 132.62, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 237.07, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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" } ], "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": 3288.36, "gross_charge": 3868.66, "discounted_cash": 2127.76, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2769.96, "standard_charge_percentage": 72.0, "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": "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": "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": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3094.93, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Seaview IPA - 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": "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": "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": "County of Ventura", "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": "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": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2127.76, "standard_charge_percentage": 55.0, "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1354.03, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - 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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1209.73, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "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": 3094.93, "standard_charge_percentage": 80.0, "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": "Santa Barbara Select IPA - 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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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" }, { "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": "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": 2514.63, "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": 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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 2901.5, "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": 1547.46, "standard_charge_percentage": 40.0, "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": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1354.03, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2162.58, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2901.5, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 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": 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": 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": 2733.98, "standard_charge_percentage": 71.0, "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": "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": "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": "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": "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": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1354.03, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3222.59, "standard_charge_percentage": 83.0, "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": 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": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2127.76, "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": 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": 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": "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": "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": "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": "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": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1547.46, "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": 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": "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" }, { "payer_name": "San Bernardino - 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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1109.92, "standard_charge_percentage": 29.0, "methodology": "percent of total billed 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2077.47, "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": 2630.69, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2475.94, "standard_charge_percentage": 64.0, "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Apple Care Medical Group St. Francis - 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": "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": "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": "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": 3288.36, "gross_charge": 3868.66, "discounted_cash": 2127.76, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2769.96, "standard_charge_percentage": 72.0, "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": 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"payer_name": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1109.92, "standard_charge_percentage": 29.0, "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": 1362.93, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2127.76, "standard_charge_percentage": 55.0, "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2911.94, "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": 2652.74, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "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": "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": 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" }, { "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": "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": 2514.63, "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": 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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "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": 2630.69, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2475.94, "standard_charge_percentage": 64.0, "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": "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": "Aetna", "plan_name": "Transplant", "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": 2514.63, "standard_charge_percentage": 65.0, "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2901.5, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "Primecare Commercial", "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": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "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": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2911.94, "standard_charge_percentage": 75.0, "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": "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": "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": "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": "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": "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": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1354.03, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3222.59, "standard_charge_percentage": 83.0, "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": 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": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2127.76, "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": 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": 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": "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": "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": "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": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1547.46, "standard_charge_percentage": 40.0, "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": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1354.03, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2162.58, "standard_charge_percentage": 56.0, "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": "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": "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": "Pinnacle 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 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": 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": 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": 2733.98, "standard_charge_percentage": 71.0, "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": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1547.46, "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": 3210.99, "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": 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": "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": "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": "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": "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": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 967.17, "standard_charge_percentage": 25.0, "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": 2901.5, "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": 2708.06, "standard_charge_percentage": 70.0, "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": "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": "Pomona Valley - 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": "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" } ], "additional_generic_notes": "" } ] }, { "description": "ABATACEPT 250 MG IV SOLR", "drug_information": { "unit": "10.000000", "type": "UN" }, "code_information": [ { "code": "00003218713", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 18753.13, "gross_charge": 3973.71, "discounted_cash": 2185.54, "setting": "outpatient", "payers_information": [ { "payer_name": "Greater LA Healthcare - 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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1242.58, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "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": 3178.97, "standard_charge_percentage": 80.0, "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": "Santa Barbara Select IPA - 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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2837.23, "standard_charge_percentage": 71.0, "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": "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": "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": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2845.18, "standard_charge_percentage": 72.0, "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": "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": "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": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3178.97, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Seaview IPA - 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": "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": "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": "County of Ventura", "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": "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": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2185.54, "standard_charge_percentage": 55.0, "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1390.8, "standard_charge_percentage": 35.0, "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": "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" }, { "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": "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": "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": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1390.8, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3310.1, "standard_charge_percentage": 83.0, "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": 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": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2185.54, "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": 2980.28, "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": 2325.02, "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": 2781.6, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "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": "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": "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": "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": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1589.48, "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": 3298.18, "standard_charge_percentage": 83.0, "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": "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": "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": "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 Vincent 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": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "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": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 2376.28, "standard_charge_percentage": 60.0, "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": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1589.48, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "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": "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": "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": "California Foundation - 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": "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": "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": "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": "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": 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": "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": "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": 2582.91, "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": 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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Mercy Healthcare Bakersfield_RRUCLA - 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": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1589.48, "standard_charge_percentage": 40.0, "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": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1390.8, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2221.3, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2980.28, "standard_charge_percentage": 75.0, "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": 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": 2781.6, "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": 2808.22, "standard_charge_percentage": 71.0, "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": "St. Jude", "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1140.06, "standard_charge_percentage": 29.0, "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": 1399.94, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2185.54, "standard_charge_percentage": 55.0, "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": "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": "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": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 993.43, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2543.17, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1347.09, "standard_charge_percentage": 34.0, "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "both", "payers_information": [ { "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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.46, "standard_charge_percentage": 83.0, "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": 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": "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": "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": "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": "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": "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": "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": "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" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.06, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 17.52, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.7, "standard_charge_percentage": 29.0, "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": 8.23, "standard_charge_percentage": 35.0, "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": "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": "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.3, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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" } ], "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": "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": "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": "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": "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 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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8938.53, "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" }, { "payer_name": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16443.97, "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": "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": "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": "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": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 8938.53, "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": 0.339, "maximum": 5106.59, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "outpatient", "payers_information": [ { "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": 22033.43, "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": 11865.0, "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": 22033.43, "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": 18643.95, "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": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.34, "standard_charge_percentage": 34.0, "estimated_amount": 10877.67, "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": 22033.43, "methodology": "percent of total billed charges" }, { "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": "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": 22033.43, "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": 22033.43, "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": 22033.43, "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": 18643.95, "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": 22033.43, "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": "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": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3983.96, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "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": "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": 20459.63, "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": "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": "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": 22033.43, "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": 15932.37, "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": 22033.43, "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": 22033.43, "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": 10287.19, "methodology": "percent of total billed charges" }, { "payer_name": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1905.44, "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": 22033.43, "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": 22033.43, "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": 25181.05, "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": 18643.95, "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": 22033.43, "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": "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": 22033.43, "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": 22033.43, "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": 8454.51, "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": 24186.42, "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": 26754.9, "methodology": "percent of total billed charges" }, { "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": "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": "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": 23607.25, "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": 28328.7, "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": 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": "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": 6935.88, "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": 16949.21, "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": 12590.53, "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": 22033.43, "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": 22033.43, "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": 85.0, "estimated_amount": 26754.9, "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": 18643.95, "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": 22033.43, "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": 25181.05, "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": 22033.43, "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": 18643.95, "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": "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": 18643.95, "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": 23607.25, "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": 22033.43, "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": 20459.63, "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": 83.0, "estimated_amount": 8454.51, "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": 22033.43, "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": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.58, "standard_charge_percentage": 58.0, "estimated_amount": 18416.29, "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": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.77, "standard_charge_percentage": 77.0, "estimated_amount": 31476.32, "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": 17616.49, "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": 21281.11, "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": 23607.25, "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": 22033.43, "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": 22033.43, "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": 18643.95, "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": 22033.43, "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": 22033.43, "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": 22033.43, "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": 20459.63, "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": 23607.25, "methodology": "percent of total billed charges" } ], "additional_generic_notes": "" } ] }, { "description": "Ablate inf turbinate superf", "code_information": [ { "code": "30801", "type": "HCPCS" } ], "standard_charges": [ { "minimum": 0.339, "maximum": 5106.59, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "outpatient", "payers_information": [ { "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": 8246.55, "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": 9540.42, "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": 8246.55, "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": 8246.55, "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": 3899.44, "methodology": "percent of total billed charges" }, { "payer_name": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1905.44, "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": 8246.55, "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": 8246.55, "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": 9424.62, "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": 8965.36, "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": 8246.55, "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": 85.0, "estimated_amount": 10013.68, "methodology": "percent of total billed charges" }, { "payer_name": "AKM Medical Group - RMG", "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": 8965.36, "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": "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": 8965.36, "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": 8835.6, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": 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"standard_charge_dollar": 3810.89, "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": "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": 2646.42, "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": 9324.77, "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": 4712.31, "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": 8246.55, "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": 7964.98, "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": 8835.6, "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": 8246.55, "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": 8246.55, "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": 8965.36, "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": 8246.55, "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": 8246.55, "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": 8246.55, "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": 7657.52, "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": 8835.6, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch Healthcare - RMG", 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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": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.58, "standard_charge_percentage": 58.0, "estimated_amount": 6858.87, "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": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.77, "standard_charge_percentage": 77.0, "estimated_amount": 11780.78, "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": 6018.89, "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": 8246.55, "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": 10403.0, "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": 8246.55, "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": 8965.36, "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": 4123.28, "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": 8246.55, "methodology": "percent of total billed charges" }, { "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": "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": 8246.55, "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": 8246.55, "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": 8246.55, "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": 8246.55, "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": 8246.55, "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": 8246.55, "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": 2197.89, "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": 9052.35, "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": 10013.68, "methodology": "percent of total billed charges" }, { "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": "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": 8835.6, "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": 8246.55, "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": 8965.36, "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": 8246.55, "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": 8246.55, "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": 7657.52, "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": "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": 7657.52, "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": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1905.44, "standard_charge_percentage": 100.0, "methodology": "fee schedule" } ], "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": "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": "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": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 13228.5, "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 12861.31, "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": "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": "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" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 17858.47, "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": "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": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 7413.14, "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": "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": "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": "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": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 10007.74, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "payer_name": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7209.21, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "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": "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" } ], "additional_generic_notes": "" } ] }, { "description": "Abltj mal prst8 tiss hifu", "code_information": [ { "code": "55880", "type": "HCPCS" } ], "standard_charges": [ { "minimum": 0.339, "maximum": 30847.25, "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": 20094.9, "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": "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": 17616.99, "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": 20094.9, "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": 17556.83, "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": 17616.99, "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": 17616.99, "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": 20094.9, "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": 18659.55, "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": 19537.57, "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": 20094.9, "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": 15526.37, "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": 17616.99, "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": 17616.99, "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": 22965.6, "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": 20094.9, "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": 17556.83, "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": "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": 17556.83, "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": 20094.9, "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": 20094.9, "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": 17556.83, "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": 20094.9, "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": 17556.83, "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": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.34, "standard_charge_percentage": 34.0, "estimated_amount": 10047.45, "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": 17616.99, "methodology": "percent of total billed charges" }, { "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": "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": 20094.9, "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": 16208.81, "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": 17616.99, "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": 12480.69, "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": 17616.99, "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": 20094.9, "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": 13549.47, "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": 19239.27, "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": 24400.95, "methodology": "percent of total billed charges" }, { "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11510.17, "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": "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": 19408.8, "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": "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": 20094.9, "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": 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": "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": "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": 7591.11, "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": 16287.79, "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": 11482.8, "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": 4505.89, "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": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 17556.83, "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": 20094.9, "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": 85.0, "estimated_amount": 24400.95, "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": 17556.83, "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": 20094.9, "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": 16660.09, "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": "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": 18659.55, "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": "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" }, { "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": 20094.9, "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": 18659.55, "methodology": "percent of total billed charges" }, { "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": "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": 20094.9, "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": 9502.02, "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": "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": 20094.9, "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": "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": "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": 21530.25, "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": 25836.3, "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": 83.0, "estimated_amount": 13549.47, "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": "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": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.58, "standard_charge_percentage": 58.0, "estimated_amount": 16801.7, "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": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.77, "standard_charge_percentage": 77.0, "estimated_amount": 28707.0, "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": 22965.6, "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": 21530.25, "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": "outpatient", "payers_information": [ { "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": "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": "First Health", "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": "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 591.59, "standard_charge_percentage": 29.0, "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": 726.44, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1134.1, "standard_charge_percentage": 55.0, "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1206.48, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": 1443.4, "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": 1319.68, "standard_charge_percentage": 64.0, "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": "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": "Aetna", "plan_name": "Transplant", "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": 1340.3, "standard_charge_percentage": 65.0, "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1546.5, "standard_charge_percentage": 75.0, "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": 1443.4, "standard_charge_percentage": 70.0, "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 644.79, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "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": 1649.6, "standard_charge_percentage": 80.0, "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": "Santa Barbara Select IPA - 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": "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": "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": "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": 824.8, "standard_charge_percentage": 40.0, "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": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 721.7, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1152.66, "standard_charge_percentage": 56.0, "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": "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": "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": "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": "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": 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": 1443.4, "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": 1457.22, "standard_charge_percentage": 71.0, "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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": 1340.3, "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": 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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1649.6, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Seaview IPA - 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": "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": "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": "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": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1134.1, "standard_charge_percentage": 55.0, "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 721.7, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "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": "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": "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": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 721.7, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 1717.65, "standard_charge_percentage": 83.0, "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": 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": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1134.1, "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": 1546.5, "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 824.8, "standard_charge_percentage": 40.0, "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": "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": "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": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 824.8, "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": 1711.46, "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": 1546.5, "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": 1478.04, "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": 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": "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": 515.5, "standard_charge_percentage": 25.0, "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": "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": "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": "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": "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": "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" } ], "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": "outpatient", "payers_information": [ { "payer_name": "St. Jude", "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": "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": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2677.67, "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": 1202.6, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 985.79, "standard_charge_percentage": 29.0, "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": 1210.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1889.8, "standard_charge_percentage": 55.0, 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"standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1889.8, "standard_charge_percentage": 55.0, "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1202.6, "standard_charge_percentage": 35.0, "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": "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": "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": "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": "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": "Sansum 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": "Lakewood 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": "Torrance Hospital - 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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2577.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2405.2, "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": 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": 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": 2405.2, "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": 2428.22, "standard_charge_percentage": 71.0, "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": "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" }, { "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": "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": "First Health", "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": "Greater San Gabriel Valley - 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 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": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1889.8, "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": 2577.0, "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": 2010.4, "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": 2405.2, "standard_charge_percentage": 70.0, "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": "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": "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": "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": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1374.4, "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": 2851.88, "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": 1374.4, "standard_charge_percentage": 40.0, "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": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1202.6, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1920.72, "standard_charge_percentage": 56.0, "methodology": "percent of total billed charges" }, { "payer_name": "St Vincent IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2405.2, "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": 2577.0, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": 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472.0, "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": "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": "California Foundation - 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": "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": "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": "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": "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": "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": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2748.8, "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": 2577.0, "standard_charge_percentage": 75.0, "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": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1202.6, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2862.19, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" }, { "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": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2199.04, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1164.8, "standard_charge_percentage": 34.0, "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": 2577.0, "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": 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": "AKM 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": "Redlands Yucaipa 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": "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": 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": 2233.4, "standard_charge_percentage": 65.0, "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": "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": 2233.4, "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": 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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Mercy Healthcare Bakersfield_RRUCLA - 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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1074.44, "standard_charge_percentage": 31.0, "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": "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" } ], "additional_generic_notes": "" } ] }, { "description": "Abortion", "code_information": [ { "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3906.18, "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": 13708.55, "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": 15206.95, "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": 14193.13, "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": 14193.13, "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": 3403.21, "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": 7096.57, "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": 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": "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": 15206.95, "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": 10918.6, "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": 10838.46, "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": 10918.6, "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": 10918.6, "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": 12478.4, "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": 3323.72, "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": 10918.6, "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, 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"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": 16220.74, "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": 11698.5, "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": 14038.2, "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": 10138.7, "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": 10918.6, "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": 10838.46, "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": 11985.5, "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": 10838.46, "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": 15598.0, "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": 11698.5, "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": 11606.89, "methodology": "percent of total billed charges" }, { "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": "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": "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": 14193.13, "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": 14193.13, "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": 13179.34, "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": 11768.2, "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": 14193.13, "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": 14193.13, "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": 15206.95, "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": 10918.6, "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": 10774.34, "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": 10918.6, "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": 10918.6, "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": "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": 13258.3, "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": 10138.7, "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": 6669.0, "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": 14193.13, "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": "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": 14193.13, "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": 14193.13, "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": 14193.13, "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": "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": 13179.34, "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": 14193.13, "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": "Monarch Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 10918.6, "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": 10138.7, "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": 83.0, "estimated_amount": 117.94, "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": 10918.6, "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": 10918.6, "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": 10918.6, "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": 10918.6, "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": 10918.6, "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": "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": "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": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3906.18, "standard_charge_percentage": 100.0, "methodology": "fee schedule" } ], "additional_generic_notes": "" } ] }, { "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 400.82, "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": 1074.21, "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": "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 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": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 837.93, "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 17579.98, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 17579.98, "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": 17579.98, "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": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 19337.98, "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": 21377.97, "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": 11332.91, "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": 7878.28, "standard_charge_percentage": 100.0, "estimated_amount": 8008.84, "methodology": "per diem" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 19337.98, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 20942.34, "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": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 26369.97, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 17579.98, "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": 17579.98, "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": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2175.0, "standard_charge_percentage": 100.0, "estimated_amount": 15500.28, "methodology": "per diem" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 17579.98, "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": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 17579.98, "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": 18979.56, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 17579.98, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 17579.98, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "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": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 23013.2, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 15342.13, "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": 15342.13, "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" }, { "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": 16483.67, "methodology": "per diem" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7878.28, "standard_charge_percentage": 100.0, "estimated_amount": 16017.68, "methodology": "per diem" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 16876.35, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 18194.14, "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": "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": 15342.13, "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": 11486.67, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 15342.13, "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": 16876.35, "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": 18572.61, "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 16488.94, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 15342.13, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 15342.13, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 15342.13, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 15342.13, "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": 15342.13, "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": "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 159.76, "standard_charge_percentage": 29.0, "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": 196.18, "standard_charge_percentage": 35.0, "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": "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 325.81, "standard_charge_percentage": 59.0, "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 463.86, "standard_charge_percentage": 83.0, "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 311.28, "standard_charge_percentage": 56.0, "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": "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 417.64, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": 398.7, "standard_charge_percentage": 72.0, "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 174.13, "standard_charge_percentage": 31.0, "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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" }, { "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": 381.83, "standard_charge_percentage": 69.0, "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": "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": "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": "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "both", "payers_information": [ { "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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 38.57, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 42.84, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.08, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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" }, { "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.57, "standard_charge_percentage": 75.0, "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": 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": "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": 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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.76, "standard_charge_percentage": 29.0, "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": 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"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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.75, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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" } ], "additional_generic_notes": "" } ] }, { "description": "Access thoracic lymph duct", "code_information": [ { "code": "38794", "type": "HCPCS" } ], "standard_charges": [ { "minimum": 0.339, "maximum": 0.85, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "outpatient", "payers_information": [ { "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": 57296.94, "methodology": "percent of total billed charges" }, { "payer_name": "Gem Care Medical Group - RMG", "plan_name": "All 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57296.94, "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": 16807.63, "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": 57296.94, "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, 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Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 43273.45, "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": 57296.94, "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": 27093.28, "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": 69574.86, "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": 57296.94, "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" }, { "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": 57296.94, "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": 43273.45, "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": 57296.94, "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": "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": 65482.21, "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": 57296.94, "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": 53204.32, "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": 42883.93, "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": 57296.94, "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": 53204.32, "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": 83.0, "estimated_amount": 16807.63, "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": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.78, "standard_charge_percentage": 78.0, "estimated_amount": 62895.68, "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": 43273.45, "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": "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" } ], "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.48, "standard_charge_percentage": 29.0, "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": 14.09, "standard_charge_percentage": 35.0, "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": "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.4, "standard_charge_percentage": 59.0, "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.32, "standard_charge_percentage": 83.0, "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.51, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.36, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "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 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": "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": "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": "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": "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": "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": "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": "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": "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 (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": "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": "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", 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"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": "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": "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": "Interplan", "plan_name": "PPO", "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", 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"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": "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": "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": "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", 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{ "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.51, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": 27.2, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "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": 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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.48, "standard_charge_percentage": 29.0, "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": 14.09, "standard_charge_percentage": 35.0, "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.36, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.32, "standard_charge_percentage": 83.0, "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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 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": "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 (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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.32, "standard_charge_percentage": 83.0, "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": 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": "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": "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": "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": "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.51, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.48, "standard_charge_percentage": 29.0, "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": 14.09, "standard_charge_percentage": 35.0, "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": "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.4, "standard_charge_percentage": 59.0, "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "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": 28.0, "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": 28.0, "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": 34.0, "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": 21.48, "standard_charge_percentage": 54.0, "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 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": "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": "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": 27.43, "standard_charge_percentage": 69.0, "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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", "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.36, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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 (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": "outpatient", "payers_information": [ { "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.51, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "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": "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": "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.32, "standard_charge_percentage": 83.0, "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.36, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.48, "standard_charge_percentage": 29.0, "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": 14.09, "standard_charge_percentage": 35.0, "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": "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": "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": "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": "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": "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": "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 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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" } ], "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": "both", "payers_information": [ { "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": "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": "Delano Medical Center", "plan_name": "HMO", "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": 16.0, "standard_charge_percentage": 40.0, "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.36, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": 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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.48, "standard_charge_percentage": 29.0, "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": 14.09, "standard_charge_percentage": 35.0, "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": "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": "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 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.32, "standard_charge_percentage": 83.0, "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": 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": "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": "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": "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.51, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.56, "standard_charge_percentage": 29.0, "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": 38.75, "standard_charge_percentage": 35.0, "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": "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.36, "standard_charge_percentage": 59.0, "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 61.49, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": "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": "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": "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.63, "standard_charge_percentage": 83.0, "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": 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": "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": "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": "Blue Shield", "plan_name": 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31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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" } ], "additional_generic_notes": "" } ] }, { "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": "outpatient", "payers_information": [ { "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.4, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.63, "standard_charge_percentage": 83.0, "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": 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": "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": "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": "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": "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": "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", "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": 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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.56, "standard_charge_percentage": 29.0, "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": 38.75, "standard_charge_percentage": 35.0, "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": "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.36, "standard_charge_percentage": 59.0, "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": "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": "Delano Medical Center", "plan_name": "HMO", "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 61.49, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.56, "standard_charge_percentage": 29.0, "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": 38.75, "standard_charge_percentage": 35.0, "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.36, "standard_charge_percentage": 59.0, "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.63, "standard_charge_percentage": 83.0, "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.4, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": 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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 61.49, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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" } ], "additional_generic_notes": "" } ] }, { "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": "both", "payers_information": [ { "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 61.49, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": 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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.56, "standard_charge_percentage": 29.0, "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": 38.75, "standard_charge_percentage": 35.0, "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": "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.36, "standard_charge_percentage": 59.0, "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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.4, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.63, "standard_charge_percentage": 83.0, "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": 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": "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": "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": "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": "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": "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", "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "" } ] }, { "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": "outpatient", "payers_information": [ { "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.4, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.56, "standard_charge_percentage": 29.0, "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": 38.75, "standard_charge_percentage": 35.0, "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": "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.36, "standard_charge_percentage": 59.0, "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "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": 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": "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": 44.0, "standard_charge_percentage": 40.0, "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 61.49, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.63, "standard_charge_percentage": 83.0, "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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" } ], "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.4, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 61.49, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.5, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.56, "standard_charge_percentage": 29.0, "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": 38.75, "standard_charge_percentage": 35.0, "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.36, "standard_charge_percentage": 59.0, "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": 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": "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": 82.5, "standard_charge_percentage": 75.0, "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": "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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.63, "standard_charge_percentage": 83.0, "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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" } ], "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", "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.36, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.51, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.48, "standard_charge_percentage": 29.0, "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": 14.09, "standard_charge_percentage": 35.0, "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.32, "standard_charge_percentage": 83.0, "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": 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": "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": "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": "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": "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": "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": "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": "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": "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 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": "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": "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": "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": "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": "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": "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": "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" } ], "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.24, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.25, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": 2.86, "standard_charge_percentage": 72.0, "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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 Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": "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": "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": "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": 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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.33, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.15, "standard_charge_percentage": 29.0, "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": 1.41, "standard_charge_percentage": 35.0, "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "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": 3.2, "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": 1.0, "standard_charge_percentage": 25.0, "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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.24, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 3.0, "standard_charge_percentage": 75.0, "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.33, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.15, "standard_charge_percentage": 29.0, "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": 1.41, "standard_charge_percentage": 35.0, "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": "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": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.25, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.24, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.15, "standard_charge_percentage": 29.0, "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": 1.41, "standard_charge_percentage": 35.0, "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": "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": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.25, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": 2.86, "standard_charge_percentage": 72.0, "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": "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": "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": "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": 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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 3.0, "standard_charge_percentage": 75.0, "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.33, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": 3.32, "standard_charge_percentage": 83.0, "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.33, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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", "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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 Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "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": "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": 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": "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.25, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "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": "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": "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": "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": "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": "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": "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": 2.86, "standard_charge_percentage": 72.0, "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.15, "standard_charge_percentage": 29.0, "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": 1.41, "standard_charge_percentage": 35.0, "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "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": 3.2, "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": 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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.24, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 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": "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": "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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 Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.33, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.15, "standard_charge_percentage": 29.0, "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": 1.41, "standard_charge_percentage": 35.0, "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "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": 3.2, "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": 1.0, "standard_charge_percentage": 25.0, "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.25, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.24, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "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": 3.32, "standard_charge_percentage": 83.0, "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.33, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.24, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.25, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.15, "standard_charge_percentage": 29.0, "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": 1.41, "standard_charge_percentage": 35.0, "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": "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": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": 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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 3.0, "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": 1.4, "standard_charge_percentage": 35.0, "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": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.15, "standard_charge_percentage": 29.0, "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": 1.41, "standard_charge_percentage": 35.0, "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": "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": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "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": "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": 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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.33, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.24, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "both", "payers_information": [ { "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": "Interplan", "plan_name": "PPO", "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": "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", 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"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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.13, "standard_charge_percentage": 31.0, "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": "Memorial Health Care - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.25, 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"standard_charge_percentage": 65.0, "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": "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": "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": "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": "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": "Redlands Yucaipa Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", 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"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": "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": "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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.79, "standard_charge_percentage": 29.0, "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": 4.65, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.27, "standard_charge_percentage": 55.0, "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.94, "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": 10.57, "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": 5.28, "standard_charge_percentage": 40.0, "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.38, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.91, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": 8.59, "standard_charge_percentage": 65.0, "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": "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": "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": "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": "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": "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": "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": "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": 9.91, "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": 9.47, "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": 9.46, "standard_charge_percentage": 72.0, "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.0, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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" } ], "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": "both", "payers_information": [ { "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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.3, "standard_charge_percentage": 29.0, "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": 2.82, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "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": "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.02, "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": 6.4, "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": 2.0, "standard_charge_percentage": 25.0, "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.66, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": 3.2, "standard_charge_percentage": 40.0, "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.47, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.5, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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" } ], "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.5, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "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": "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": "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": "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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.3, "standard_charge_percentage": 29.0, "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": 2.82, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "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": "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.02, "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": 6.4, "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": 2.0, "standard_charge_percentage": 25.0, "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "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", "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": 5.2, "standard_charge_percentage": 65.0, "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.0, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.66, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.47, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "both", "payers_information": [ { "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 51.73, "standard_charge_percentage": 40.0, "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 37.1, "standard_charge_percentage": 29.0, "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": 45.56, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.13, "standard_charge_percentage": 55.0, "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 75.67, "standard_charge_percentage": 59.0, "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Primecare Transplant", "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": "County of Ventura", "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": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 82.77, "standard_charge_percentage": 64.0, "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": "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": "Aetna", "plan_name": "Transplant", "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": 84.06, "standard_charge_percentage": 65.0, "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 97.0, "standard_charge_percentage": 75.0, "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": 90.53, "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": 36.21, "standard_charge_percentage": 28.0, "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 107.73, "standard_charge_percentage": 83.0, "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": 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": "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": "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": "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": "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": "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": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 51.73, "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": 92.6, "standard_charge_percentage": 72.0, "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": "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": "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": "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": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 103.46, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 51.73, "standard_charge_percentage": 40.0, "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 72.3, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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 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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 40.44, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 90.53, "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": 90.53, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": 107.34, "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": 92.7, "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": 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": "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": "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" } ], "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": "outpatient", "payers_information": [ { "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.33, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "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": 3.41, "standard_charge_percentage": 80.0, "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": "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": "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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.22, "standard_charge_percentage": 29.0, "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": 1.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.34, "standard_charge_percentage": 55.0, "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.21, "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": 3.41, "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": 1.07, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.19, "standard_charge_percentage": 28.0, "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.55, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.38, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.2, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": 3.05, "standard_charge_percentage": 72.0, "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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" }, { "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "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": "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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 3.2, "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": 2.9, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": 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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.27, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.05, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.38, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.16, "standard_charge_percentage": 29.0, "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": 1.43, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.23, "standard_charge_percentage": 55.0, "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.06, "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": 3.25, "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": 1.02, "standard_charge_percentage": 25.0, "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.27, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": 2.78, "standard_charge_percentage": 69.0, "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": "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": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Seoul Medical Group - RMG", "plan_name": "All 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"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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 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": 2.91, "standard_charge_percentage": 72.0, "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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" } ], "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": "outpatient", "payers_information": [ { "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.18, "standard_charge_percentage": 29.0, "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": 2.68, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "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": "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.73, "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": 6.09, "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": 1.9, "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": 3.04, "standard_charge_percentage": 40.0, "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.25, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.71, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 6.34, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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" }, { "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.38, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": 5.22, "standard_charge_percentage": 69.0, "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 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" } ], "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": "both", "payers_information": [ { "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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": 43.06, "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": 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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "Seaview IPA - 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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": 43.06, "standard_charge_percentage": 65.0, "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 49.69, "standard_charge_percentage": 75.0, "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": 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": 26.5, "standard_charge_percentage": 40.0, "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 37.03, "standard_charge_percentage": 56.0, "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": "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": "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": "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": "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": 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": "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": "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": "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": "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": "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": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.19, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 55.19, "standard_charge_percentage": 83.0, "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": 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": "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": "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": "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": "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": "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": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.5, "standard_charge_percentage": 40.0, "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.72, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Santa Barbara Select IPA - 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": "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": "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": "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": "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": "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": "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": "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" }, { "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": "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": "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": "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": "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": 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": "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": "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": "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": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.5, "standard_charge_percentage": 40.0, "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": "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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.01, "standard_charge_percentage": 29.0, "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": 23.34, "standard_charge_percentage": 35.0, "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": "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": "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": "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" } ], "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.32, "standard_charge_percentage": 83.0, "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.36, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": 27.43, "standard_charge_percentage": 69.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.51, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.48, "standard_charge_percentage": 29.0, "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": 14.09, "standard_charge_percentage": 35.0, "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": "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": "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 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" } ], "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", "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": 26.67, "standard_charge_percentage": 65.0, "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.77, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.18, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.94, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.77, "standard_charge_percentage": 29.0, "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": 14.45, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.57, "standard_charge_percentage": 55.0, "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.88, "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": 32.82, "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": 10.26, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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" }, { "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.83, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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" } ], "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.8, "standard_charge_percentage": 70.0, "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": "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": "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": "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.24, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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 Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": "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": "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": "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": 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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.15, "standard_charge_percentage": 29.0, "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": 1.41, "standard_charge_percentage": 35.0, "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": "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.33, "standard_charge_percentage": 83.0, "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.25, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.24, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.25, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.33, "standard_charge_percentage": 83.0, "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": 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": "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": "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": "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": "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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 Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": 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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.15, "standard_charge_percentage": 29.0, "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": 1.41, "standard_charge_percentage": 35.0, "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.34, "standard_charge_percentage": 59.0, "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": "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "both", "payers_information": [ { "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 40.71, "standard_charge_percentage": 56.0, "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": "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 54.62, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.77, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.89, "standard_charge_percentage": 29.0, "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": 25.65, "standard_charge_percentage": 35.0, "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": "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": 47.33, "standard_charge_percentage": 65.0, "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 60.66, "standard_charge_percentage": 83.0, "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": 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": "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": "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": "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": "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": "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": "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": "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" }, { "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": "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": "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": "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": "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": "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": "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" } ], "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": "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": "First Health", "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": "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 75.12, "standard_charge_percentage": 29.0, "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": 92.25, "standard_charge_percentage": 35.0, "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": "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 153.21, "standard_charge_percentage": 59.0, "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 218.12, "standard_charge_percentage": 83.0, "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": 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": "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": "Facey 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": "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": "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 81.88, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "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": 183.3, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Medicare", "plan_name": "Medicare", "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": 209.48, "standard_charge_percentage": 80.0, "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 186.96, "standard_charge_percentage": 71.0, "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": "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": "Cedars Sinai - 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", "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": "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": "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": "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": "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": "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": "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": "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": "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": "Alamitos IPA 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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 104.74, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 183.3, "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": 1235.75, "standard_charge_percentage": 472.0, "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": "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": "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": "California Foundation - 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": "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": "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": "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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "MemorialCare Medical Foundation - 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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 146.37, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 196.39, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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" }, { "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "ACETYLCYSTEINE 20 % IN SOLN", "drug_information": { "unit": "3.000000", "type": "UN" }, "code_information": [ { "code": "00517760425_2", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 7.94, "gross_charge": 9.34, "discounted_cash": 5.14, "setting": "outpatient", "payers_information": [ { "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": "First Health", "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": "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.68, "standard_charge_percentage": 29.0, "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": 3.29, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "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": "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.03, "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": 7.47, "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": 2.34, "standard_charge_percentage": 25.0, "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.22, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.01, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.92, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Santa Barbara Select IPA - 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": "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": "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": "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": "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" }, { "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": "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": "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": 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": "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": "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": 6.07, "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": 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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 7.01, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Aetna", "plan_name": "All Products", "additional_payer_notes": "N/A", 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"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": "Seaview IPA - 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": "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": "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": "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": "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": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.14, "standard_charge_percentage": 55.0, "methodology": 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"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": 2.62, "standard_charge_percentage": 28.0, "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.78, "standard_charge_percentage": 83.0, "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": 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": 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"additional_payer_notes": "N/A", "standard_charge_dollar": 7.47, "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": 7.18, "standard_charge_percentage": 77.0, "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "ACETYLCYSTEINE 20 % IN SOLN (INHALATION)", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "00517760425", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 3.4, "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": "Interplan", "plan_name": "PPO", "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": "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", 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"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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.15, "standard_charge_percentage": 29.0, "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": 1.41, "standard_charge_percentage": 35.0, "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": "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": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.25, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": 2.86, "standard_charge_percentage": 72.0, "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.33, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.24, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": 3.32, "standard_charge_percentage": 83.0, "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": "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": "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": "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": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 29.32, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 69.79, "standard_charge_percentage": 83.0, "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": 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": "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": "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": "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": "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": "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": "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": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.51, "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": 59.99, "standard_charge_percentage": 72.0, "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": "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": "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": "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": "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": "Seaview IPA - 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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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": 54.46, "standard_charge_percentage": 65.0, "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": "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": 54.46, "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": 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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.2, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Santa Barbara Select IPA - 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": "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": "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": "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": "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": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.51, "standard_charge_percentage": 40.0, "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 46.83, "standard_charge_percentage": 56.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum 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": "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": "Torrance Hospital - 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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 62.84, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 24.04, "standard_charge_percentage": 29.0, "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": 29.52, "standard_charge_percentage": 35.0, "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": "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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 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"additional_payer_notes": "N/A", "standard_charge_dollar": 395.38, "standard_charge_percentage": 472.0, "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": "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": "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": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 44.99, "standard_charge_percentage": 54.0, 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"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": "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" } ], "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": "both", "payers_information": [ { "payer_name": "Private 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"plan_name": "All 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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 34.4, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "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": "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": "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": "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": "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": "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": "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": "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": "First Health", "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": "Greater 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"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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.56, "standard_charge_percentage": 29.0, "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": 38.75, "standard_charge_percentage": 35.0, "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 64.36, "standard_charge_percentage": 59.0, "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": "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 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 91.63, "standard_charge_percentage": 83.0, "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 61.49, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "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": "both", "payers_information": [ { "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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 127.17, "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": 115.3, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 127.17, "standard_charge_percentage": 75.0, "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": 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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.02, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 141.24, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 48.65, "standard_charge_percentage": 29.0, "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": 59.74, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 127.63, "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": 135.65, "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": 42.39, "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": 67.82, "standard_charge_percentage": 40.0, "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 94.78, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "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": 118.69, "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": 140.73, "standard_charge_percentage": 83.0, "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": "both", "payers_information": [ { "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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "Prime Health - 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"methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Health 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"methodology": "percent of total billed charges" }, { "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": "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": "Aetna", "plan_name": "Transplant", "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": 45.29, "standard_charge_percentage": 65.0, "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 52.25, "standard_charge_percentage": 75.0, "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": 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": "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": 49.88, "standard_charge_percentage": 72.0, "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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" }, { "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.99, "standard_charge_percentage": 29.0, "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": 24.54, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 52.44, "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": 55.74, "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": 17.42, "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": 27.87, "standard_charge_percentage": 40.0, "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.95, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "Cigna", "plan_name": 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"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": 37.41, "standard_charge_percentage": 54.0, "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 21.79, "standard_charge_percentage": 31.0, "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": "Memorial Health Care - RMG", "plan_name": "All 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"additional_payer_notes": "N/A", "standard_charge_dollar": 45.29, "standard_charge_percentage": 65.0, "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": "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 58.04, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "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" } ], "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.47, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.56, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.53, "standard_charge_percentage": 29.0, "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": 14.16, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.1, "standard_charge_percentage": 55.0, "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.24, "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": 32.14, "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": 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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.46, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.14, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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 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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": 16.07, "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": 33.35, "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": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 23894.8, "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": 22551.48, "methodology": "per diem" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 16908.75, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 15719.33, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 15719.33, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 23579.0, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 15719.33, "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": 15719.33, "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": 7878.28, "standard_charge_percentage": 100.0, "estimated_amount": 16017.68, "methodology": "per diem" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 17291.27, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 18657.37, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "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": "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": 15719.33, "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": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 15719.33, "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": 17291.27, "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": 19045.46, "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 15719.33, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 15719.33, "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": 15719.33, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "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": "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": 25515.46, "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": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 25515.46, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 25515.46, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 25515.46, "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": 25515.46, "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": 28067.01, "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": 31325.88, "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": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7878.28, "standard_charge_percentage": 100.0, "estimated_amount": 56061.88, "methodology": "per diem" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 28067.01, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 30687.53, "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": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 39302.04, "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": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 38273.19, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 25515.46, "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": 25515.46, "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": 27811.41, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 25515.46, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 25515.46, "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": "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": 43817.62, "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": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 43817.62, "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": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2175.0, "standard_charge_percentage": 100.0, "estimated_amount": 98998.1, "methodology": "per diem" }, { "payer_name": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 43817.62, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 43817.62, "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": 43817.62, "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": 7878.28, "standard_charge_percentage": 100.0, "estimated_amount": 96106.08, "methodology": "per diem" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 48199.39, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 53163.57, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "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": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 48199.39, "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": 54269.44, "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 48180.93, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 43817.62, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 43817.62, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 65726.44, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 43817.62, "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": 43817.62, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "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": 17268.58, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 16042.65, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 16042.65, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 24063.98, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 16042.65, "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": 16042.65, "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": 7878.28, "standard_charge_percentage": 100.0, "estimated_amount": 8008.84, "methodology": "per diem" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 17646.92, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 19054.41, "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": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 24403.31, "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" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 17646.92, "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": 19450.77, "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16042.65, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 16042.65, "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": 16042.65, "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": 16042.65, "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": 12029.8, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 16042.65, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 34378.09, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 37815.91, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 34378.09, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 51567.15, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 34378.09, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 34378.09, "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": 37815.91, "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": 34378.09, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 34378.09, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 34378.09, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 34378.09, "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": 34378.09, "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 88127.63, "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": 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": 96940.4, "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": 88127.63, "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": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 88127.63, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 88127.63, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 96940.4, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 88127.63, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 88127.63, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 132191.45, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 88127.63, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 88127.63, "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": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 146524.02, "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": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 161176.43, "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": 183022.03, "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, 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"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": 109816.4, "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": 7878.28, "standard_charge_percentage": 100.0, "estimated_amount": 88097.24, "methodology": "per diem" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 97496.04, "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": 58215.96, "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": 67918.58, "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": 238271.2, "methodology": "per diem" }, { "payer_name": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 107578.61, "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 92175.24, "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-NonCity of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 25246.27, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 24731.81, "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": 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": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 31674.45, "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": "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" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 22413.88, "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": 7878.28, "standard_charge_percentage": 100.0, "estimated_amount": 24026.52, "methodology": "per diem" } ], "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 18961.99, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18961.99, "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": 18961.99, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "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": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 20858.19, "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": 23110.46, "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": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 28994.82, "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": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18961.99, "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": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 18961.99, "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": 7878.28, "standard_charge_percentage": 100.0, "estimated_amount": 24026.52, "methodology": "per diem" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 20858.19, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 22639.52, "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": 28442.99, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18961.99, "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": 18961.99, "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": 20517.68, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18961.99, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18961.99, "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": 16915.39, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7878.28, "standard_charge_percentage": 100.0, "estimated_amount": 16017.68, "methodology": "per diem" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12404.62, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 13201.85, "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": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 16915.39, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 11276.92, "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": 11276.92, "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": 12404.62, "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": 13476.46, "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 11964.53, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 11276.92, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 11276.92, "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": 11276.92, "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": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 11276.92, "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11276.92, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 11276.92, "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": 11276.92, "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": 15136.1, "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": 11326.93, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 15136.1, "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": 7878.28, "standard_charge_percentage": 100.0, "estimated_amount": 16017.68, "methodology": "per diem" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 16649.71, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 17941.12, "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": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 16649.71, "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": 18314.32, "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": 9708.8, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 22704.15, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 15136.1, "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": 15136.1, "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": 16259.63, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 15136.1, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 15136.1, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 15136.1, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 15136.1, "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": 15136.1, "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": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2175.0, "standard_charge_percentage": 100.0, "estimated_amount": 29799.78, "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": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 29194.97, "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": 32611.34, "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": "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": 26540.87, "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": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 26540.87, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 26540.87, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 26540.87, "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": 26540.87, "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": 28952.65, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 26540.87, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 26540.87, "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": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2175.0, "standard_charge_percentage": 100.0, "estimated_amount": 44928.47, "methodology": "per diem" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 39811.32, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 26540.87, "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": 26540.87, "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": 7878.28, "standard_charge_percentage": 100.0, "estimated_amount": 40044.2, "methodology": "per diem" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 29194.97, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 31946.8, "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": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18027.97, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12018.64, "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": 12018.64, "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": 13220.51, "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": 14406.29, "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": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18074.4, "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": 29732.25, "methodology": "per diem" }, { "payer_name": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 12790.04, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12018.64, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12018.64, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 12018.64, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12018.64, "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": 12018.64, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12018.64, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12018.64, "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": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 12018.64, "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": 7878.28, "standard_charge_percentage": 100.0, "estimated_amount": 16017.68, "methodology": "per diem" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 13220.51, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 14112.72, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 12092.03, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 13070.5, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12270.64, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12270.64, "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": "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": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7878.28, "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": 13497.71, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 14422.19, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 12270.64, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12270.64, "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": 12270.64, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { 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"Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12270.64, "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": 12270.64, "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": 13497.71, "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": 14722.19, "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" } ], "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": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 48741.81, "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": 177707.12, "methodology": "per diem" }, { "payer_name": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 31517.39, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Health Plan of Nevada 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"methodology": "case rate" }, { "payer_name": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "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": 31517.39, "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": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 31517.39, "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": 14136.3, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7878.28, "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": 10366.62, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 10926.61, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9362.11, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { 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"methodology": "per diem" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 10366.62, "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": 11153.9, "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9424.2, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 9424.2, 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"standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 9424.2, "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" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 9424.2, "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.33, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.24, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.15, "standard_charge_percentage": 29.0, "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": 1.41, "standard_charge_percentage": 35.0, "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": "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": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.25, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": 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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 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": "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": "outpatient", "payers_information": [ { "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.25, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "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": "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": "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": "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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 Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "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": "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": 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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.33, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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", "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.24, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.15, "standard_charge_percentage": 29.0, "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": 1.41, "standard_charge_percentage": 35.0, "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "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": 3.2, "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": 1.0, "standard_charge_percentage": 25.0, "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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 Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "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": "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": 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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.33, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.24, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.15, "standard_charge_percentage": 29.0, "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": 1.41, "standard_charge_percentage": 35.0, "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "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": 3.2, "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": 1.0, "standard_charge_percentage": 25.0, "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": 3.32, "standard_charge_percentage": 83.0, "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.25, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "both", "payers_information": [ { "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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 26.96, "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": 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": "First Health", "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": "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.31, "standard_charge_percentage": 29.0, "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": 12.67, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "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": "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.06, "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": 28.76, "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": 8.99, "standard_charge_percentage": 25.0, "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.24, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.1, "standard_charge_percentage": 56.0, "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": "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.96, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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" }, { "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": 23.37, "standard_charge_percentage": 65.0, "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": "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": "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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 29.95, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "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" } ], "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": "outpatient", "payers_information": [ { "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.33, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.24, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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 Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": 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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.15, "standard_charge_percentage": 29.0, "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": 1.41, "standard_charge_percentage": 35.0, "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "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": 3.2, "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": 1.0, "standard_charge_percentage": 25.0, "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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 3.0, "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": 1.4, "standard_charge_percentage": 35.0, "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": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "outpatient", "payers_information": [ { "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": "First Health", "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": "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.64, "standard_charge_percentage": 29.0, "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": 16.75, "standard_charge_percentage": 35.0, "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": "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.82, "standard_charge_percentage": 59.0, "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": 30.91, "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": 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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "Seaview IPA - 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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 16.64, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 39.61, "standard_charge_percentage": 83.0, "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": 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": "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": "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": "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": "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": "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": "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": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.02, "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": 32.33, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 35.66, "standard_charge_percentage": 75.0, "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": 33.29, "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": 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": "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": "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": "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": "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": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.02, "standard_charge_percentage": 40.0, "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": "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": "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": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 19.02, "standard_charge_percentage": 40.0, "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.58, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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 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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.87, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Santa Barbara Select IPA - 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": "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": "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": "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": "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": "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": "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" } ], "additional_generic_notes": "" } ] }, { "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": 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total billed charges" }, { "payer_name": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7053.55, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 2698.22, "standard_charge_percentage": 29.0, "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": 3313.29, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "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": "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7078.94, "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": 7523.78, "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": 6733.79, "standard_charge_percentage": 72.0, "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": 6113.07, "standard_charge_percentage": 65.0, "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": "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": "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 7834.14, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 2940.86, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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/0.4ML SC PSKT", "drug_information": { "unit": "1.000000", "type": "UN" }, "code_information": [ { "code": "00074024302", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 7994.02, "gross_charge": 9404.73, "discounted_cash": 5172.6, "setting": "both", "payers_information": [ { "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": "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": "Interplan", "plan_name": "PPO", "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", 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"N/A", "standard_charge_dollar": 7476.76, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "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": 6395.22, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": 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6583.31, "standard_charge_percentage": 70.0, "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": "Aetna", "plan_name": "Transplant", "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": 6113.07, "standard_charge_percentage": 65.0, "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7053.55, "standard_charge_percentage": 75.0, "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": 6583.31, "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": 7053.55, "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": 6733.79, "standard_charge_percentage": 72.0, "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 2940.86, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5257.24, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 2698.22, "standard_charge_percentage": 29.0, "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": 3313.29, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7078.94, "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": 7523.78, "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": 2633.32, "standard_charge_percentage": 28.0, "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 7834.14, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": 5050.34, "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": 7805.93, "standard_charge_percentage": 83.0, "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 2940.86, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5257.24, "standard_charge_percentage": 56.0, "methodology": "percent of total billed charges" }, { "payer_name": "Sansum Clinic - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", 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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": 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": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", 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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": "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": "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": 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"additional_payer_notes": "N/A", "standard_charge_dollar": 6395.22, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Centinela Valley IPA - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", 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"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": "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": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Facey Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", 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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 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 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": "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": "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" } ], "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": "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": "First Health", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7994.02, "standard_charge_percentage": 85.0, "methodology": "percent of total 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"additional_payer_notes": "N/A", "standard_charge_dollar": 7994.02, "standard_charge_percentage": 85.0, "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 2698.22, "standard_charge_percentage": 29.0, "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": 3313.29, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "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": "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7078.94, "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": 7523.78, "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": 6733.79, "standard_charge_percentage": 72.0, "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 7834.14, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "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": "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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "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": 3761.89, "standard_charge_percentage": 40.0, "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5257.24, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7053.55, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 2940.86, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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" }, { "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": "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": "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": "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": "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": "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 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" } ], "additional_generic_notes": "" } ] }, { "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": "both", "payers_information": [ { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 12897.68, "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": 15047.61, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13166.66, "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": 13166.66, "standard_charge_percentage": 70.0, "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", "standard_charge_dollar": 8840.47, "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": 0.01, "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": 12226.18, "standard_charge_percentage": 65.0, "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": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10909.52, "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": 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": "Blue Shield", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 14953.56, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "MemorialCare Medical Foundation - 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": "Cigna", "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": 13467.61, "standard_charge_percentage": 72.0, "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": "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": "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": "Physicians Choice Medical Group San Luis Obispo - 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", "standard_charge_dollar": 15047.61, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Seaview IPA - 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": "Tri Valley - 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", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6470.47, "standard_charge_percentage": 34.0, "methodology": "percent of total billed charges" }, { "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": "County of Ventura", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13166.66, "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": 13166.66, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10345.23, "standard_charge_percentage": 55.0, "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.33, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Pomona Valley - 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": "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": "First Health", "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": "Greater San Gabriel Valley - 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": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 11059.99, "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": 15988.08, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 14658.25, "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": 6583.33, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 5396.45, "standard_charge_percentage": 29.0, "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": 6626.59, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10345.23, "standard_charge_percentage": 55.0, "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 14157.92, "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": 15047.61, "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": 14107.13, "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": 13166.66, "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": 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": "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": "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": "Primecare Commercial", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13166.66, "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": 7523.8, "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": 14157.92, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15038.2, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7523.8, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "PIH Health Physicians - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13166.66, "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": 15988.08, "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": 12790.47, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Gem Care 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 Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Primecare Transplant", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13166.66, "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": 12038.09, "standard_charge_percentage": 64.0, "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Monarch", "plan_name": "Medicare", 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"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": 7523.8, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "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": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.33, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 10514.52, "standard_charge_percentage": 56.0, "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, "standard_charge_percentage": 70.0, "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": "Premier Physician - 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": "Pinnacle 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 Mary 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": "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": "Korean American 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": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 13292.68, "standard_charge_percentage": 71.0, "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": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5266.66, "standard_charge_percentage": 28.0, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 15668.32, "standard_charge_percentage": 83.0, "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": 13166.66, "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": 13166.66, "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": 10100.71, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 10345.23, "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": 14107.13, "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": 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": "TakeCare HMO", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15047.61, "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": 14453.23, "standard_charge_percentage": 77.0, "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 5881.73, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6583.33, "standard_charge_percentage": 35.0, "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", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7730.71, "standard_charge_percentage": 41.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 13166.66, "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": 13166.66, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Santa Barbara Select IPA - 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": "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": "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": "United Family 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": "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": 7523.8, "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": 15611.89, "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": 13482.66, "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": 14107.13, "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": 13166.66, "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": 10100.71, "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": 4702.38, "standard_charge_percentage": 25.0, "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": "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": "" } ] }, { "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": "both", "payers_information": [ { "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": "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": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1586.41, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2533.73, "standard_charge_percentage": 56.0, "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": "Lakewood 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": "Torrance Hospital - 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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3399.46, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "St. Jude", "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": "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": "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": "Physicians Choice Medical Group Santa Maria - 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": "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": "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": "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": "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": "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": "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": "Alamitos IPA 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": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2492.94, "standard_charge_percentage": 55.0, "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1586.41, "standard_charge_percentage": 35.0, "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": "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": "Interplan", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3172.83, "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": 3172.83, "standard_charge_percentage": 70.0, "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "MemorialCare Medical Foundation - 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": "Cigna", "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": 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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1300.41, "standard_charge_percentage": 29.0, "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": 1596.84, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "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": "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3411.7, "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": 3626.09, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Greater LA Healthcare - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1586.41, "standard_charge_percentage": 35.0, "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": 1417.35, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1586.41, "standard_charge_percentage": 35.0, "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": "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" }, { "payer_name": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Santa Barbara Select 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": "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": 2946.2, "standard_charge_percentage": 65.0, "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": "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": "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": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1269.13, "standard_charge_percentage": 28.0, "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": "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": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1586.41, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3775.66, "standard_charge_percentage": 83.0, "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": 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": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2492.94, "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": 3399.46, "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": 0.01, "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": "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": "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": "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": 1133.15, "standard_charge_percentage": 25.0, "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": "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": "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" }, { "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": "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": "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": "Private Healthcare System PHC- PPO", "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": "Axminister 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": "Family Care Specialists - 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": "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": "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": "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": "Cigna", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3411.7, "standard_charge_percentage": 75.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3623.82, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 1813.04, "standard_charge_percentage": 40.0, "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": "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": "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": "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": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" } ], "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": "inpatient", "payers_information": [ { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": 32.22, "standard_charge_percentage": 65.0, "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 37.18, "standard_charge_percentage": 75.0, "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": 34.7, "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": 37.18, "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": 17.35, "standard_charge_percentage": 35.0, "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": 15.5, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "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": 39.66, "standard_charge_percentage": 80.0, "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": "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": "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": "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": "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": "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": "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" }, { "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": 19.83, "standard_charge_percentage": 40.0, "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 27.71, "standard_charge_percentage": 56.0, "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": "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": "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": "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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "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": "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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 41.29, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.22, "standard_charge_percentage": 29.0, "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": 17.46, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 37.31, "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": 39.66, "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": 12.39, "standard_charge_percentage": 25.0, "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": "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": "Anthem Medicare", "plan_name": "Medicare", "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": 362.66, "standard_charge_percentage": 80.0, "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": "Santa Barbara Select IPA - 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": "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": "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": "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": "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": 181.33, "standard_charge_percentage": 40.0, "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 253.41, "standard_charge_percentage": 56.0, "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": "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": "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": "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": "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": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "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": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 265.24, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "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": "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": "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": "California Foundation - 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": "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" }, { "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": "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": "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": "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": "Physicians Choice Medical Group San Luis Obispo - 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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 339.99, "standard_charge_percentage": 75.0, "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": 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": 317.32, "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": 320.36, "standard_charge_percentage": 71.0, "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Gem Care 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": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 362.66, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": 294.66, "standard_charge_percentage": 65.0, "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": "Apple Care Medical Group St. Francis - 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": "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": "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": 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": "First Health", "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": "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": "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": "Blue Shield", "plan_name": "EPN", "additional_payer_notes": "N/A", "standard_charge_dollar": 243.43, "standard_charge_percentage": 54.0, "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": "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": "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": "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": "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": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 181.33, "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": 376.26, "standard_charge_percentage": 83.0, "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 141.75, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Pomona Valley - 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": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 310.84, "standard_charge_percentage": 69.0, "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": "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": 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": "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": "Seaview IPA - 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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 130.06, "standard_charge_percentage": 29.0, "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": 159.7, "standard_charge_percentage": 35.0, "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 265.24, "standard_charge_percentage": 59.0, "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": "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": "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": "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": "Redlands Yucaipa 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 Vincent 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": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 339.99, "standard_charge_percentage": 75.0, "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": "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": 294.66, "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": 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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "San Bernardino - 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": "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": "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": "Access 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": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 158.66, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 377.62, "standard_charge_percentage": 83.0, "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": 317.32, "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": 317.32, "standard_charge_percentage": 70.0, "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": "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.48, "standard_charge_percentage": 29.0, "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": 14.09, "standard_charge_percentage": 35.0, "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": "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23.4, "standard_charge_percentage": 59.0, "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 12.51, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "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": "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": "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": "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 22.36, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "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": "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 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 33.32, "standard_charge_percentage": 83.0, "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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" } ], "additional_generic_notes": "" } ] }, { "description": "Adjmt/revj ext fixj sys anes", "code_information": [ { "code": "20693", "type": "HCPCS" } ], "standard_charges": [ { "minimum": 0.339, "maximum": 23955.25, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "outpatient", "payers_information": [ { "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": 46677.77, "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": 44057.77, "methodology": "percent of total billed charges" }, { "payer_name": "Prudent Medical Group - RMG", "plan_name": "All Products", 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"standard_charge_dollar": 5278.0, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "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": 43957.77, "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": 44717.77, "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": 41143.61, "methodology": "percent of total billed charges" }, { "payer_name": "Upland 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": 44197.77, "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": 23955.25, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "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": 16530.35, "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": 44197.77, "methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", 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"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": 10473.19, "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": 51238.81, "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": 44197.77, "methodology": "percent of total billed charges" }, { "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": "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": 8938.53, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "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": 43957.77, "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": "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": 43957.77, "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": 43957.77, "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": 23338.89, "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": 40903.61, "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": 44197.77, "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": 50011.88, "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": 46677.77, "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": 44197.77, "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": 43957.77, "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": 44197.77, "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": 41003.61, "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": "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": 44197.77, "methodology": "percent of total billed charges" }, { "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": "California Foundation - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.85, "standard_charge_percentage": 85.0, "estimated_amount": 53345.99, "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": 44197.77, "methodology": "percent of total billed charges" }, { "payer_name": "Family Health Alliance - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", 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"N/A", "standard_charge_dollar": 0.8, "standard_charge_percentage": 80.0, "estimated_amount": 34680.13, "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": "both", "payers_information": [ { "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": "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" }, { 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"payer_name": "Facey 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": "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": "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": "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": "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": "Greater LA Healthcare - 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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 3687.36, "standard_charge_percentage": 31.0, "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": "Memorial Health 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": "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": "CenCal Transplant 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": "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": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 8254.41, "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": 8254.41, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Santa Barbara Select 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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8419.5, "standard_charge_percentage": 71.0, "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Primecare Transplant", "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": "County of Ventura", "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": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 7546.89, "standard_charge_percentage": 64.0, "methodology": "percent of total billed charges" }, { "payer_name": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3997.49, "standard_charge_percentage": 34.0, "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8844.01, "standard_charge_percentage": 75.0, "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": 8254.41, "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": 8443.08, "standard_charge_percentage": 72.0, "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": "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": "UHC HMO", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9207.2, "standard_charge_percentage": 78.0, "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": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 9433.61, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "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": "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": "Alamitos IPA 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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Torrance Hospital - 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": "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": "Redlands Yucaipa 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 Vincent 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": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 8844.01, "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": 7051.62, "standard_charge_percentage": 60.0, "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": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4716.8, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 55650.03, "standard_charge_percentage": 472.0, "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": "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": "Monarch Healthcare - 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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6591.73, "standard_charge_percentage": 56.0, "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": "Lakewood 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": "Premier Physician - 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": "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": 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": "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": "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": "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": "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": "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": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2948.0, "standard_charge_percentage": 25.0, "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": "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": "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": "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": "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" }, { "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": "California Foundation - 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": "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" } ], "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": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 40310.66, "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": 45279.17, "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": 24003.43, "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": 36646.05, "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": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 36646.05, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 36646.05, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 36646.05, "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": 36646.05, "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": 7878.28, "standard_charge_percentage": 100.0, "estimated_amount": 16017.68, "methodology": "per diem" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 40310.66, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 44356.5, "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": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 56808.11, "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": 53878.57, "methodology": "per diem" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 54969.09, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 36646.05, "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": 36646.05, "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": 40199.28, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 36646.05, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 36646.05, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "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": 34856.99, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 23237.99, "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": 23237.99, "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": 25561.79, "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": 28470.84, "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": "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": 23237.99, "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": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 23237.99, "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": 25276.69, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 23237.99, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 23237.99, "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": 7878.28, "standard_charge_percentage": 100.0, "estimated_amount": 8008.84, "methodology": "per diem" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 25561.79, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 27890.68, "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" }, { "payer_name": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23237.99, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 23237.99, "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": 23237.99, "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": "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" } ], "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 531.05, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 712.5, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 272.56, "standard_charge_percentage": 29.0, "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": 334.69, "standard_charge_percentage": 35.0, "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": "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": 617.5, "standard_charge_percentage": 65.0, "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 297.07, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": 680.2, "standard_charge_percentage": 72.0, "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 791.35, "standard_charge_percentage": 83.0, "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": 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": "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": "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": "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": "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": "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": "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" } ], "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": "outpatient", "payers_information": [ { "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1156.55, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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 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"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": "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": "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": "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": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": 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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": 3080.92, "standard_charge_percentage": 83.0, "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": 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": 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"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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "Kaiser", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2174.77, "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": 3143.79, "standard_charge_percentage": 85.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2882.3, "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": 1294.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1061.12, "standard_charge_percentage": 29.0, "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": 1303.01, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2034.22, "standard_charge_percentage": 55.0, "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2164.04, "standard_charge_percentage": 59.0, "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": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 924.65, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1479.43, "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": 3069.82, "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": 2515.03, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": 2589.01, "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": 2367.09, "standard_charge_percentage": 64.0, "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2773.94, "standard_charge_percentage": 75.0, "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": 2589.01, "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": 2773.94, "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": "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": "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": "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": "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": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2958.86, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Seaview IPA - 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": "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" }, { "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": "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": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2034.22, "standard_charge_percentage": 55.0, "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1294.5, "standard_charge_percentage": 35.0, "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": "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": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1479.43, "standard_charge_percentage": 40.0, "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": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1294.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2067.51, "standard_charge_percentage": 56.0, "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": "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": "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": "Premier Physician - 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": "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": 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": 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": 2613.79, "standard_charge_percentage": 71.0, "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": "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": "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": "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": "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": "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": "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": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1479.43, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "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" }, { "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": "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": "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": 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": "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": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2145.18, "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": 2404.08, "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": 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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Mercy Healthcare Bakersfield_RRUCLA - 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": "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" } ], "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1592.3, "standard_charge_percentage": 29.0, "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": 1955.27, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3052.5, "standard_charge_percentage": 55.0, "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3247.31, "standard_charge_percentage": 59.0, "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": 2220.0, "standard_charge_percentage": 40.0, "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": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1942.5, "standard_charge_percentage": 35.0, "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3102.45, "standard_charge_percentage": 56.0, "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": "Lakewood 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": "Torrance Hospital - 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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4162.5, "standard_charge_percentage": 75.0, "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": 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": 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": 3922.19, "standard_charge_percentage": 71.0, "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": "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": "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": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1387.5, "standard_charge_percentage": 25.0, "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": "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": "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": "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": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 4440.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Seaview IPA - 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": "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": "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": "County of Ventura", "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": "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": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3052.5, "standard_charge_percentage": 55.0, "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1942.5, "standard_charge_percentage": 35.0, "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": "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": "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": "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": "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": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1942.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 4623.15, "standard_charge_percentage": 83.0, "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": 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": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3052.5, "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": 4162.5, "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": 3247.31, "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": 3885.0, "standard_charge_percentage": 70.0, "methodology": "percent of total billed charges" }, { "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": "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": "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": "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": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2220.0, "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": 4606.5, "standard_charge_percentage": 83.0, "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1735.49, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Santa Barbara Select IPA - 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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": 3607.5, "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": 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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Mercy Healthcare Bakersfield_RRUCLA - 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" }, { "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": "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": "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": "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": "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": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2220.0, "standard_charge_percentage": 40.0, "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": "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": "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 3552.0, "standard_charge_percentage": 64.0, "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "both", "payers_information": [ { "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": "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": "Interplan", "plan_name": "PPO", "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", 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100.0, "methodology": "other" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 2086.16, "standard_charge_percentage": 35.0, "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": "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": "First Health", "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": "Greater San Gabriel Valley - RMG", "plan_name": "All Products", 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"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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1710.06, "standard_charge_percentage": 29.0, "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": 2099.87, "standard_charge_percentage": 35.0, "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 4470.35, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1863.84, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "Beaver Medical Group - RMG", "plan_name": "All Products", "additional_payer_notes": 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"percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3331.9, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": 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": 4212.26, "standard_charge_percentage": 71.0, "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": "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": "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": "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 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": "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": "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": "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": "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": "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": "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": "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": "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" } ], "additional_generic_notes": "" } ] }, { "description": "After cataract laser surgery", "code_information": [ { "code": "66821", "type": "HCPCS" } ], "standard_charges": [ { "minimum": 0.339, "maximum": 6353.0, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "outpatient", "payers_information": [ { "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": 1480.96, "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": 1524.5, "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": 1480.96, "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": 1524.5, "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": 1183.07, "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": 740.48, "methodology": "percent of total billed charges" }, { "payer_name": "Pinnacle Medical Group - 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"additional_payer_notes": "N/A", "standard_charge_dollar": 0.35, "standard_charge_percentage": 35.0, "estimated_amount": 1253.6, "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": 1611.6, "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": 1253.6, "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": 1480.96, "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": 840.39, "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": 1377.63, "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": 1798.3, "methodology": "percent of total billed charges" }, { "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 726.26, "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": 1480.96, "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": 1480.96, "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": 1375.17, "methodology": "percent of total billed charges" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 941.02, "standard_charge_percentage": 100.0, 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"standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "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": 1375.17, "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": "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": 1324.12, "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": 1480.96, "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": 1559.34, "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": 1253.6, "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": 1253.6, "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": 1692.52, "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": 1480.96, "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": 1524.5, "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" }, { "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": 1524.5, "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": 1480.96, "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": 1480.96, "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": 1253.6, "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": 1253.6, "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": 1480.96, "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": 1524.5, "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": 1253.6, "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": 1253.6, "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": 1480.96, "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": 1375.17, "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": 1345.84, "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": 1430.39, "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": 1324.12, "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": 1480.96, "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": 1253.6, "methodology": "percent of total billed charges" }, { "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": "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": 713.05, "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": 1546.28, "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": 846.26, "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": 513.98, "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": 0.7, "standard_charge_percentage": 70.0, "estimated_amount": 1524.5, "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": 1586.74, "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": 1904.09, "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": 83.0, "estimated_amount": 840.39, "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": 1253.6, "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": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.58, "standard_charge_percentage": 58.0, "estimated_amount": 1245.04, "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": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.77, "standard_charge_percentage": 77.0, "estimated_amount": 2115.65, "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": 1692.52, "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": 1586.74, "methodology": "percent of total billed charges" } ], "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 19032.48, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 17627.52, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 17627.52, "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": 7878.28, "standard_charge_percentage": 100.0, "estimated_amount": 16017.68, "methodology": "per diem" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 19390.28, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 21000.73, "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": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 19390.28, "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": 21437.57, "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": 11364.5, "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": 17627.52, "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": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 17627.52, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 17627.52, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 17627.52, "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": 17627.52, "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": "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" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 26441.29, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 17627.52, "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": 17627.52, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "AFTERCARE WITHOUT CC/MCC", "code_information": [ { "code": "950", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 2175.0, "maximum": 14723.5, "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": 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": 9815.66, "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": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 9815.66, "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": 7878.28, "standard_charge_percentage": 100.0, "estimated_amount": 8008.84, "methodology": "per diem" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 10797.23, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 11407.35, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "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": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 14723.5, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 9815.66, "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": 9815.66, "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": 10338.22, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 9815.66, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 9815.66, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9815.66, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 9815.66, "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": 9815.66, "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": 10797.23, "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": 11644.63, "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": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 14609.58, "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" } ], "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": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 28384.11, "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": 25369.14, "methodology": "per diem" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7878.28, "standard_charge_percentage": 100.0, "estimated_amount": 24026.52, "methodology": "per diem" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 20431.07, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 22162.68, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 18989.37, "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": 20431.07, "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": 22623.69, "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 20085.53, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18573.69, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18573.69, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 27860.55, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18573.69, "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": 18573.69, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18573.69, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18573.69, "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": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 18573.69, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 18573.69, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 18573.69, "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": 18573.69, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "559", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 2175.0, "maximum": 46271.56, "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": 32941.46, "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": 36880.97, "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": 19551.37, "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": 7878.28, "standard_charge_percentage": 100.0, "estimated_amount": 32035.36, "methodology": "per diem" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 32941.46, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 36129.43, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30956.33, "standard_charge_percentage": 100.0, 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"standard_charge_dollar": 14536.72, "standard_charge_percentage": 65.0, "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": 7827.47, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 18629.37, "standard_charge_percentage": 83.0, "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": 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": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12300.3, "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": 16773.14, "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": 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": "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": "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": "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": "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": "Greater LA Healthcare - 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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 6993.28, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Santa Barbara Select IPA - 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": "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": "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": "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": "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" }, { "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": "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": "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": "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": "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": "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": "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": "AKM 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": "Redlands Yucaipa 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": "St Vincent 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": "Prime Health- Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 16773.14, "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": 11394.0, "standard_charge_percentage": 60.0, "methodology": "percent of total billed charges" }, { "payer_name": "Primecare Commercial", "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": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8945.68, "standard_charge_percentage": 40.0, "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": "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": "PIH Health Physicians - 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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "St Joseph Heritage - 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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7581.46, "standard_charge_percentage": 34.0, "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 16958.77, "standard_charge_percentage": 76.0, "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": 15654.93, "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": 19009.56, "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": 12009.57, "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": 16773.14, "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": "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": "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" } ], "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": "both", "payers_information": [ { "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": "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": "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 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"standard_charge_dollar": 1277.74, "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": 1869.01, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": 2076.32, "standard_charge_percentage": 65.0, "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2395.76, "standard_charge_percentage": 75.0, "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": 2236.04, "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": 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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 916.46, "standard_charge_percentage": 29.0, "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": 1125.37, "standard_charge_percentage": 35.0, "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1869.01, "standard_charge_percentage": 59.0, "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1785.64, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2660.89, "standard_charge_percentage": 83.0, "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": 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": "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": "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": "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": "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 998.87, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Alamitos IPA LOA - RMG", 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"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": "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" } ], "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": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 77976.49, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Medicare", "plan_name": 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"standard_charge_dollar": 61000.0, "standard_charge_percentage": 100.0, "estimated_amount": 162802.3, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "AICD LEAD PROCEDURES", "code_information": [ { "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": "Anthem Blue Cross", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 19891.0, "standard_charge_percentage": 100.0, "estimated_amount": 999999999.0, "methodology": "per diem" }, { "payer_name": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 57062.44, "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": 7878.28, 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"methodology": "case rate" }, { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 37571.32, "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": "First Health", "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": "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": 19768.69, "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": 19749.31, "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": 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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.83, "standard_charge_percentage": 83.0, "estimated_amount": 2288.97, "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": "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": "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": 19784.19, "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": 19749.31, "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": 19749.31, "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": 19749.31, "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": 19749.31, "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": 28213.29, "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": 21159.98, "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": 19749.31, "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": 19768.69, "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": "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": "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": 19749.31, "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": 19749.31, "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": 2288.97, "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": 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" }, { "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": "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": "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": "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": "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": 21159.98, "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": 25391.96, "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": "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": "inpatient", "payers_information": [ { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.18, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.63, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 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" }, { "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": 8.35, "standard_charge_percentage": 65.0, "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": "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.02, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.7, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.68, "standard_charge_percentage": 29.0, "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": 4.52, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.06, "standard_charge_percentage": 55.0, "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 9.66, "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": 10.27, "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": 3.21, "standard_charge_percentage": 25.0, "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": "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": "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": "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": "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": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "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": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 125.21, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "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": "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": "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", "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": 149.8, "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": 136.96, "standard_charge_percentage": 64.0, "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": "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": "Aetna", "plan_name": "Transplant", "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": 139.1, "standard_charge_percentage": 65.0, "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": 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": "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": "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": 139.1, "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": 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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 61.4, "standard_charge_percentage": 29.0, "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": 75.39, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 117.7, "standard_charge_percentage": 55.0, "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": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 85.6, "standard_charge_percentage": 40.0, "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 119.63, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "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": "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": "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": "Seaview IPA - 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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Mercy Healthcare Bakersfield_RRUCLA - 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": "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": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.5, "standard_charge_percentage": 25.0, "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": "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": "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": "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": "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": "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": "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": "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": "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": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.9, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 178.26, "standard_charge_percentage": 83.0, "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": 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": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 117.7, "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": 160.5, "standard_charge_percentage": 75.0, "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": "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": "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": "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": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 85.6, "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": 177.62, "standard_charge_percentage": 83.0, "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 66.92, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Santa Barbara Select IPA - 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": "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": "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": "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": "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": "both", "payers_information": [ { "payer_name": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 85.6, "standard_charge_percentage": 40.0, "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 119.63, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 61.4, "standard_charge_percentage": 29.0, "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": 75.39, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 117.7, "standard_charge_percentage": 55.0, "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 125.21, "standard_charge_percentage": 59.0, "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": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.5, "standard_charge_percentage": 25.0, "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 66.92, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Santa Barbara Select IPA - 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": "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": "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": "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": "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": "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": "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": "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": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.9, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 178.26, "standard_charge_percentage": 83.0, "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": 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": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 117.7, "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": 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": "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": "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": "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": "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": "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": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 85.6, "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": 177.62, "standard_charge_percentage": 83.0, "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": "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": "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": "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": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 85.6, "standard_charge_percentage": 40.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "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", "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": 149.8, "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": 136.96, "standard_charge_percentage": 64.0, "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "Seaview IPA - 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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": 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": "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": "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": 139.1, "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": 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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Mercy Healthcare Bakersfield_RRUCLA - 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 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": "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": "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": "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": "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": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "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": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 125.21, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 66.92, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "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": "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": "Santa Barbara Select IPA - 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": "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": "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": "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": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 85.6, "standard_charge_percentage": 40.0, "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 119.63, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "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": "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": "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": 153.22, "standard_charge_percentage": 72.0, "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": "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": "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": "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": "Seaview IPA - 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": "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": "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": "County of Ventura", "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 136.96, "standard_charge_percentage": 64.0, "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": "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": "Aetna", "plan_name": "Transplant", "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": 139.1, "standard_charge_percentage": 65.0, "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 61.4, "standard_charge_percentage": 29.0, "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": 75.39, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 117.7, "standard_charge_percentage": 55.0, "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 125.21, "standard_charge_percentage": 59.0, "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": 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": "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": "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": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.5, "standard_charge_percentage": 25.0, "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": "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": "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": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.9, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 178.26, "standard_charge_percentage": 83.0, "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": 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": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 117.7, "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": 160.5, "standard_charge_percentage": 75.0, "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": "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": "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": "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": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 85.6, "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": 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": "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": "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": 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": "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": "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": 139.1, "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": 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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Mercy Healthcare Bakersfield_RRUCLA - 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 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": "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": "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": "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": "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": "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": "Seaview IPA - 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": "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": "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": "County of Ventura", "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 66.92, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "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": "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": "Santa Barbara Select IPA - 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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": 139.1, "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": 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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 61.4, "standard_charge_percentage": 29.0, "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": 75.39, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 117.7, "standard_charge_percentage": 55.0, "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": "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": "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": "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": "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": "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": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "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": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 125.21, "standard_charge_percentage": 59.0, "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": "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": "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": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 85.6, "standard_charge_percentage": 40.0, "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 119.63, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "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": 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": "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": "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": 145.52, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 136.96, "standard_charge_percentage": 64.0, "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": "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": "Aetna", "plan_name": "Transplant", "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": 139.1, "standard_charge_percentage": 65.0, "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": "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": "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": "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": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.9, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 178.26, "standard_charge_percentage": 83.0, "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": 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": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 117.7, "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": 160.5, "standard_charge_percentage": 75.0, "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": "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": "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": "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": "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": 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": "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": "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": "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": "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": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.5, "standard_charge_percentage": 25.0, "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": 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": "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": 85.6, "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": 177.62, "standard_charge_percentage": 83.0, "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": "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": "" } ] }, { "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": "outpatient", "payers_information": [ { "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": 149.8, "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": 136.96, "standard_charge_percentage": 64.0, "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": "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": "Aetna", "plan_name": "Transplant", "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": 139.1, "standard_charge_percentage": 65.0, "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "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": 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": 153.22, "standard_charge_percentage": 72.0, "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": "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": "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": "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": "Seaview IPA - 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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 66.92, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "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": "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": "Santa Barbara Select IPA - 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": "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": "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": "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": "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": "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": "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": "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": "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": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "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": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 125.21, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "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": "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": "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": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.9, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 178.26, "standard_charge_percentage": 83.0, "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": 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": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 117.7, "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": 160.5, "standard_charge_percentage": 75.0, "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": "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": "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": "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": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 85.6, "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": 85.6, "standard_charge_percentage": 40.0, "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 119.63, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 61.4, "standard_charge_percentage": 29.0, "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": 75.39, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 117.7, "standard_charge_percentage": 55.0, "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 125.21, "standard_charge_percentage": 59.0, "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": "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": "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": "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": 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": "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": "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": 139.1, "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": 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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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 Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.5, "standard_charge_percentage": 25.0, "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": "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": "Mercy Healthcare Bakersfield_RRUCLA - 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 % 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": "outpatient", "payers_information": [ { "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": 149.8, "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": 136.96, "standard_charge_percentage": 64.0, "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": "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": "Aetna", "plan_name": "Transplant", "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": 139.1, "standard_charge_percentage": 65.0, "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "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": 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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 61.4, "standard_charge_percentage": 29.0, "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": 75.39, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 117.7, "standard_charge_percentage": 55.0, "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 125.21, "standard_charge_percentage": 59.0, "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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": 139.1, "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": 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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.9, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 178.26, "standard_charge_percentage": 83.0, "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": 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": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 117.7, "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": 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": "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": "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": "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": "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": "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": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.5, "standard_charge_percentage": 25.0, "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": 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": "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": 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": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 85.6, "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": 177.62, "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": 153.22, "standard_charge_percentage": 72.0, "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": "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": "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": "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": "Seaview IPA - 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": "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": "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": "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": "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": "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": "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": 85.6, "standard_charge_percentage": 40.0, "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 119.63, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 85.6, "standard_charge_percentage": 40.0, "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 66.92, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Santa Barbara Select IPA - 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": "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": "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": "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": "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": "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": "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" } ], "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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": 139.1, "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": 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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 85.6, "standard_charge_percentage": 40.0, "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 119.63, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.5, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 61.4, "standard_charge_percentage": 29.0, "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": 75.39, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 117.7, "standard_charge_percentage": 55.0, "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": "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": "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": "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": "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": "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": "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": "Seaview IPA - 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": "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": "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": "County of Ventura", "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": 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": "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": "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": "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": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 53.5, "standard_charge_percentage": 25.0, "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": "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": "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": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 74.9, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 178.26, "standard_charge_percentage": 83.0, "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": 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": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 117.7, "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": 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": "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": "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": "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": "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": "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": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 85.6, "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": 177.62, "standard_charge_percentage": 83.0, "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": "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": "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": "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": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 85.6, "standard_charge_percentage": 40.0, "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": "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": "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 66.92, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Santa Barbara Select IPA - 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": "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": "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 136.96, "standard_charge_percentage": 64.0, "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "outpatient", "payers_information": [ { "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.73, "standard_charge_percentage": 29.0, "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": 88.08, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 137.5, "standard_charge_percentage": 55.0, "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 146.28, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "UHC Select/SelectPlus", "plan_name": "Select-Select Plus", "additional_payer_notes": "N/A", "standard_charge_dollar": 171.43, "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": 200.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": 162.5, "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": 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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 100.0, "standard_charge_percentage": 40.0, "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": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 139.75, "standard_charge_percentage": 56.0, "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": "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 187.5, "standard_charge_percentage": 75.0, "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": 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": 175.0, "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": 176.68, "standard_charge_percentage": 71.0, "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": "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": "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": "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": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 208.25, "standard_charge_percentage": 83.0, "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": 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": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 137.5, "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": 187.5, "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 100.0, "standard_charge_percentage": 40.0, "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": 175.0, "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": 160.0, "standard_charge_percentage": 64.0, "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": 62.5, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "payer_name": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 100.0, "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": 207.5, "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": 187.5, "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": "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": "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": "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": "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": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 200.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Seaview IPA - 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": "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": "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": "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": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 137.5, "standard_charge_percentage": 55.0, "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.5, "standard_charge_percentage": 35.0, "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": 187.5, "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": 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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 78.18, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Santa Barbara Select IPA - 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": "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": "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": "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": "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": "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": "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": "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" } ], "additional_generic_notes": "" } ] }, { "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": "both", "payers_information": [ { "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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": 162.5, "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": 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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 71.73, "standard_charge_percentage": 29.0, "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": 88.08, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 137.5, "standard_charge_percentage": 55.0, "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": "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": "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": "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": "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": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 208.25, "standard_charge_percentage": 83.0, "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": 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": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 137.5, "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": 187.5, "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": 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": "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": "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 78.18, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Santa Barbara Select IPA - 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": "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": "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": "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": "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": 62.5, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "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": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 100.0, "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": 207.5, "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": 187.5, "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": 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": "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": "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": "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": "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": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 100.0, "standard_charge_percentage": 40.0, "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": "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": "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": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 100.0, "standard_charge_percentage": 40.0, "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": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.5, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 139.75, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 187.5, "standard_charge_percentage": 75.0, "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": 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": 175.0, "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": 176.68, "standard_charge_percentage": 71.0, "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": "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": "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": "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": "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": "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": "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": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 200.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Seaview IPA - 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": "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": "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": "County of Ventura", "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": "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": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 137.5, "standard_charge_percentage": 55.0, "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 87.5, "standard_charge_percentage": 35.0, "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 160.0, "standard_charge_percentage": 64.0, "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "outpatient", "payers_information": [ { "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.25, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.33, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.15, "standard_charge_percentage": 29.0, "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": 1.41, "standard_charge_percentage": 35.0, "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": "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": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.24, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 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 (5 MG/ML) 0.5% IN NEBU", "drug_information": { "unit": "3.000000", "type": "UN" }, "code_information": [ { "code": "00487990130", "type": "NDC" }, { "code": "69374033005", "type": "NDC" }, { "code": "73177014632", "type": "NDC" } ], "standard_charges": [ { "minimum": 0.01, "maximum": 3.4, "gross_charge": 4.0, "discounted_cash": 2.2, "setting": "outpatient", "payers_information": [ { "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.15, "standard_charge_percentage": 29.0, "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": 1.41, "standard_charge_percentage": 35.0, "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": "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": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "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": "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.33, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.24, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.25, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "" }, { "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.98, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.75, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.83, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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", "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.82, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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" }, { 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total billed charges" }, { "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": "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": "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": "UHC PPO", "plan_name": "PPO", "additional_payer_notes": 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"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": "" }, { "minimum": 0.01, "maximum": 31.88, "gross_charge": 37.5, "discounted_cash": 20.63, "setting": "outpatient", "payers_information": [ { "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": "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": "Access 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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 31.24, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.73, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "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": 30.0, "standard_charge_percentage": 80.0, "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.13, "standard_charge_percentage": 75.0, "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": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 15.0, "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": 31.13, "standard_charge_percentage": 83.0, "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": 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": "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": "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": "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": "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" }, { "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 28.13, "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.96, "standard_charge_percentage": 56.0, "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": "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": "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": "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": "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": 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": "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": "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": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.88, "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": 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": "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": "Redlands Yucaipa 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 Vincent 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": "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": "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": "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": "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": "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": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15.0, "standard_charge_percentage": 40.0, "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": "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": "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": "Saint Johns - 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": "Multiplan", "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.76, "standard_charge_percentage": 29.0, "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": 13.21, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.63, "standard_charge_percentage": 55.0, "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.23, "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": 30.0, "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": 9.38, "standard_charge_percentage": 25.0, "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": "3.000000", "type": "UN" }, "code_information": [ { "code": "00487990130_2", "type": "NDC" }, { "code": "73177014632_2", "type": "NDC" }, { "code": "69374033005_2", "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.15, "standard_charge_percentage": 29.0, "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": 1.41, "standard_charge_percentage": 35.0, "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": "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": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.24, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.25, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.33, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": 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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "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": 2.15, "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": 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", 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"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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 10.76, "standard_charge_percentage": 29.0, "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": 13.21, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.63, "standard_charge_percentage": 55.0, "methodology": "percent of total billed charges" }, { "payer_name": "Kern Family", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 30.0, "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": "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": "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Health Plan of Nevada Commercial", "plan_name": "All 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"standard_charge_percentage": 70.0, "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": 26.25, "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": 26.25, "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": 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": 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"methodology": "percent of total billed charges" }, { "payer_name": "UCI University - RMG", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 15.0, "standard_charge_percentage": 40.0, "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": "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": "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": "Saint Johns - 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": "Multiplan", "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": "First Health", "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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 28.13, "standard_charge_percentage": 75.0, "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": "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": "CenCal Transplant 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": "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": "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 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"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": "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": "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": "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" }, { "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.96, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "Optum", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 26.88, "standard_charge_percentage": 72.0, "methodology": "percent of total billed charges" }, { "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": "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": "Access 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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.73, "standard_charge_percentage": 31.0, "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" } ], "additional_generic_notes": "" }, { "minimum": 0.01, "maximum": 21.25, "gross_charge": 25.0, "discounted_cash": 13.75, "setting": "both", "payers_information": [ { "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": 17.0, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.75, "standard_charge_percentage": 75.0, "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": 17.5, "standard_charge_percentage": 70.0, "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.82, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.83, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.98, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "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": 17.92, "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": 21.25, "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": 13.43, "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": 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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.17, "standard_charge_percentage": 29.0, "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": 8.81, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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 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": "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": "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": "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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": "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": "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 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": "both", "payers_information": [ { "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.1, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "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": 7.93, "standard_charge_percentage": 80.0, "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": "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": "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": "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": 6.44, "standard_charge_percentage": 65.0, "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.43, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.54, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.84, "standard_charge_percentage": 29.0, "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": 3.49, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.46, "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": 7.93, "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": 2.48, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.26, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 7.43, "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": "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" }, { "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" } ], "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": "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 3.0, "standard_charge_percentage": 75.0, "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.33, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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", "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.25, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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 Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.15, "standard_charge_percentage": 29.0, "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": 1.41, "standard_charge_percentage": 35.0, "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "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": 3.2, "standard_charge_percentage": 80.0, "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": "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 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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.24, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": 3.32, "standard_charge_percentage": 83.0, "methodology": "percent of total billed charges" } ], "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": "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": "First Health", "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": "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.17, "standard_charge_percentage": 29.0, "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": 8.81, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "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": "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.82, "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": 17.0, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.75, "standard_charge_percentage": 75.0, "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": 17.5, "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": 10.0, "standard_charge_percentage": 40.0, "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.98, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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 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": "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": "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": "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": 17.9, "standard_charge_percentage": 72.0, "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.82, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.83, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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" } ], "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.98, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.75, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 20.83, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "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": 17.0, "standard_charge_percentage": 68.0, "methodology": "percent of total billed charges" }, { "payer_name": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.82, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.17, "standard_charge_percentage": 29.0, "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": 8.81, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 18.82, "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": "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": 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": "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": "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": "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 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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" } ], "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": "outpatient", "payers_information": [ { "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 15.93, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": 33.1, "standard_charge_percentage": 65.0, "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.2, "standard_charge_percentage": 75.0, "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": 35.65, "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": 38.2, "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.61, "standard_charge_percentage": 29.0, "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": 17.94, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.34, "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": 20.37, "standard_charge_percentage": 40.0, "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.47, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 42.42, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 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": "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": "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": "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": "outpatient", "payers_information": [ { "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": "First Health", "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": "Greater San Gabriel 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"standard_charge_percentage": 85.0, "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 14.61, "standard_charge_percentage": 29.0, "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": 17.94, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "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": "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.34, "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": 40.74, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": 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"standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": 33.1, "standard_charge_percentage": 65.0, "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 38.2, "standard_charge_percentage": 75.0, "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": 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": 36.47, "standard_charge_percentage": 72.0, "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 15.93, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 42.42, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28.47, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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" } ], "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 23474.14, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 23474.14, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": 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"payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 25821.55, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 23474.14, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 23474.14, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 23474.14, "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": 23474.14, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 23474.14, "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": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 31625.22, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 28750.19, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Monarch", 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"additional_payer_notes": "N/A", "standard_charge_dollar": 10417.92, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "Alcohol/drug abuse or dependence w rehabilitation therapy", "code_information": [ { "code": "895", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 2175.0, "maximum": 36091.47, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Central Health Plan", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 15249.92, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 28180.68, "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": 7878.28, "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": 28766.88, "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": 17791.56, "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": 25539.51, "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": "Centivo", "plan_name": "PPO", 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"additional_payer_notes": "N/A", "standard_charge_dollar": 17527.55, "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": 10840.33, "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 14711.88, "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": 23066.69, "methodology": "per diem" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", 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"methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6661.76, "standard_charge_percentage": 40.0, "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": "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": "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": "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": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 4163.6, "standard_charge_percentage": 25.0, "methodology": "percent of total billed charges" }, { "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": "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": "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": "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": "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": 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": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 6661.76, "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": 13823.16, "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": 11937.88, "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": 14156.25, "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": 8943.42, "standard_charge_percentage": 54.0, "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": "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": "Interplan", "plan_name": "PPO", "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": "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", 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RMG", "plan_name": "All 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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.25, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.33, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.24, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.15, "standard_charge_percentage": 29.0, "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": 1.41, "standard_charge_percentage": 35.0, "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": "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": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" } ], "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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 3.0, "standard_charge_percentage": 75.0, "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.33, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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 Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.24, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": 3.32, "standard_charge_percentage": 83.0, "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.25, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.15, "standard_charge_percentage": 29.0, "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": 1.41, "standard_charge_percentage": 35.0, "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "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": 3.2, "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": 1.0, "standard_charge_percentage": 25.0, "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.25, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "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": "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": "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": "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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.15, "standard_charge_percentage": 29.0, "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": 1.41, "standard_charge_percentage": 35.0, "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": "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": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.24, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.33, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.33, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.24, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.15, "standard_charge_percentage": 29.0, "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": 1.41, "standard_charge_percentage": 35.0, "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": "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": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.25, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": 2700.4, "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": 2468.94, "standard_charge_percentage": 64.0, "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": "Centinela Valley 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": "Aetna", "plan_name": "Transplant", "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": 2507.52, "standard_charge_percentage": 65.0, "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2893.29, "standard_charge_percentage": 75.0, "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": 2700.4, "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": 2893.29, "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": 2700.4, "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": 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": "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": "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": "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": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "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": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2257.15, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1206.31, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "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": 3086.18, "standard_charge_percentage": 80.0, "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": "Santa Barbara Select IPA - 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": "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": "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": "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": "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": "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": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1350.2, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3213.48, "standard_charge_percentage": 83.0, "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": 2700.4, "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": 2700.4, "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": 2071.6, "standard_charge_percentage": 54.0, "methodology": "percent of total billed charges" }, { "payer_name": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2121.75, "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": 2893.29, "standard_charge_percentage": 75.0, "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": "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": "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": "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": "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": "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": "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": 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": "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": "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": 2507.52, "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": 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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 3086.18, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Seaview IPA - 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": "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": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1570.09, "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": 3279.06, "standard_charge_percentage": 85.0, "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": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2121.75, "standard_charge_percentage": 55.0, "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1350.2, "standard_charge_percentage": 35.0, "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": 1543.09, "standard_charge_percentage": 40.0, "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": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1350.2, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2156.47, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": 2700.4, "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": 2726.25, "standard_charge_percentage": 71.0, "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1106.78, "standard_charge_percentage": 29.0, "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": 1359.07, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2121.75, "standard_charge_percentage": 55.0, "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": "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": "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": "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": "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": "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": "Molina Healthcare HMO", "plan_name": "MediCal HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1543.09, "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": 3201.91, "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": 3086.18, "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": 964.43, "standard_charge_percentage": 25.0, "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": 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": "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": "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": "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" } ], "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": "outpatient", "payers_information": [ { "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 668.7, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 602.07, "standard_charge_percentage": 75.0, "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": 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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 251.02, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "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": "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": "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": "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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 230.31, "standard_charge_percentage": 29.0, "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": 282.81, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 604.24, "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": 642.21, "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": 200.69, "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": 321.1, "standard_charge_percentage": 40.0, "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 448.74, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 602.07, "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": "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" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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" } ], "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": "outpatient", "payers_information": [ { "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.88, "standard_charge_percentage": 29.0, "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": 3.53, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "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": "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.55, "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": 8.02, "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": 2.51, "standard_charge_percentage": 25.0, "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.14, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "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": 8.02, "standard_charge_percentage": 80.0, "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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", "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": 6.52, "standard_charge_percentage": 65.0, "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7.52, "standard_charge_percentage": 75.0, "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": 7.02, "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": 7.52, "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": "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "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" }, { "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 5.61, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.35, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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" } ], "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": "inpatient", "payers_information": [ { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.95, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "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": 12.66, "standard_charge_percentage": 80.0, "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": "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": "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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 4.54, "standard_charge_percentage": 29.0, "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": 5.58, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "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": "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.92, "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": 12.66, "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": 3.96, "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": 6.33, "standard_charge_percentage": 40.0, "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 8.85, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11.87, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": 10.29, "standard_charge_percentage": 65.0, "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": "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": "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": "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": "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 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" }, { "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 13.19, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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" } ], "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": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 30877.31, "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": 34528.6, "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 28070.28, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 28070.28, "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": 28070.28, "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 30654.82, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 28070.28, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 28070.28, "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": "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": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 28070.28, "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": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 28070.28, "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": 7878.28, "standard_charge_percentage": 100.0, "estimated_amount": 56061.88, "methodology": "per diem" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 30877.31, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 33824.99, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "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": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 42105.43, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 28070.28, "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": 28070.28, "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": 16577.81, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7878.28, "standard_charge_percentage": 100.0, "estimated_amount": 8008.84, "methodology": "per diem" }, { "payer_name": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 12157.06, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 12925.47, "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": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 16577.81, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 11051.87, "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": 11051.87, "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": 12157.06, "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": 13194.34, "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": "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": 11051.87, "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": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 11051.87, "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": "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": 11714.06, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 11051.87, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 11051.87, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 11051.87, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 11051.87, "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": 11051.87, "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": 0.339, "maximum": 44069.83, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "outpatient", "payers_information": [ { "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": 37232.87, "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": 31331.59, "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": "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": "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": "Optum", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 37447.99, "standard_charge_percentage": 100.0, "methodology": "fee schedule" }, { "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": "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": 34573.38, "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": "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": "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": 37232.87, "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": 26610.57, "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": 37232.87, "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": 37232.87, "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": 17601.86, "methodology": "percent of total billed charges" }, { "payer_name": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 16443.97, "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": 37232.87, "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": 37232.87, "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": 42551.83, "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": 31331.59, "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": 37232.87, "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": 34573.38, "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": 83.0, "estimated_amount": 20659.53, "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": 37232.87, "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": "Redlands Community General Services", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.58, "standard_charge_percentage": 58.0, "estimated_amount": 30870.82, "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": "UHC Imdemity", "plan_name": "Indemity", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.77, "standard_charge_percentage": 77.0, "estimated_amount": 53189.8, "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": 33557.42, "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": 35961.6, "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": 39892.36, "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": 37232.87, "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": 37232.87, "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": 31331.59, "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": 37232.87, "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": 37232.87, "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": 37232.87, "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": 34573.38, "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": 39892.36, "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": 37232.87, "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": 19529.05, "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": 37232.87, "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": 31331.59, "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": "UC Ship", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.34, "standard_charge_percentage": 34.0, "estimated_amount": 18612.22, "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": 37232.87, "methodology": "percent of total billed charges" }, { "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": "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": 37232.87, "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": 37232.87, "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": 39892.36, "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": 47870.82, "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": 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": "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": 12213.24, "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": 28380.96, "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": 21275.92, "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": 37232.87, "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": 37232.87, "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": 37232.87, "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": 37232.87, "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": 37232.87, "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": 20659.53, "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": 40871.06, "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": 45211.32, "methodology": "percent of total billed charges" }, { "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": "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": "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": 37232.87, "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": 85.0, "estimated_amount": 45211.32, "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": 31331.59, "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": 37232.87, "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": 42551.83, "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": 37232.87, "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": 31331.59, "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": "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": 31331.59, "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": 39892.36, "methodology": "percent of total billed charges" } ], "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": "014ALLOR", "type": "MS-DRG" }, { "code": "007-1-4ALLOR", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 105000.0, "maximum": 163500.0, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 105000.0, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "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" }, { "code": "014ALLOU", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 125000.0, "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" }, { "payer_name": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 125000.0, "standard_charge_percentage": 100.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "Allogeneic Blood/Marrow Matched/Mismatched Related", "code_information": [ { "code": "014-BMTALLOR", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 308532.0, "maximum": 308532.0, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 308532.0, "standard_charge_percentage": 100.0, "estimated_amount": 999999999.0, "methodology": "case rate" } ], "additional_generic_notes": "" } ] }, { "description": "Allogeneic Blood/Marrow Matched/Mismatched Unrelated", "code_information": [ { "code": "014-BMTALLOU", "type": "MS-DRG" } ], "standard_charges": [ { "minimum": 308532.0, "maximum": 308532.0, "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 308532.0, "standard_charge_percentage": 100.0, "estimated_amount": 999999999.0, "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": "UHC Mediare Advantage", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 208174.17, "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 208174.17, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 208174.17, "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": 208174.17, "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": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 228991.59, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 255002.17, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "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": "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" }, { "payer_name": "Gold Coast Health Plan", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 7878.28, "standard_charge_percentage": 100.0, "estimated_amount": 340760.0, "methodology": "per diem" }, { "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": "Med-Cal Transplant", "plan_name": "Medicaid", "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": 281035.14, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Primecare Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 208174.17, "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": 160992.82, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Redlands Community Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 208174.17, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Aetna Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 208174.17, "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": "Prime Health - Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 312261.26, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 208174.17, "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": 137993.92, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "payer_name": "Med-Cal Transplant", "plan_name": "Medicaid", "additional_payer_notes": "N/A", "standard_charge_dollar": 292464.0, "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": "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": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 208174.17, "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 231102.65, "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": 345051.0, "standard_charge_percentage": 100.0, "estimated_amount": 999999999.0, "methodology": "case rate" }, { "payer_name": "Torrance Memorial Medicare", "plan_name": "HMO-Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 228991.59, "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": 260306.56, "standard_charge_percentage": 100.0, "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": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 522628.0, "standard_charge_percentage": 100.0, "methodology": "case rate" }, { "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" } ], "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": "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": "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": "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" }, { "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": "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": "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": "Med-Cal Transplant", "plan_name": "Medicaid", "additional_payer_notes": "N/A", "standard_charge_dollar": 753251.0, "standard_charge_percentage": 100.0, "estimated_amount": 999999999.0, "methodology": "case rate" }, { "payer_name": "Med-Cal Transplant", "plan_name": "Medicaid", "additional_payer_notes": "N/A", "standard_charge_dollar": 436213.0, "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": "Med-Cal Transplant", "plan_name": "Medicaid", "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-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" }, { "payer_name": "Med-Cal Transplant", "plan_name": "Medicaid", "additional_payer_notes": "N/A", "standard_charge_dollar": 290200.0, "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": "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": "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" } ], "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.15, "standard_charge_percentage": 29.0, "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": 1.41, "standard_charge_percentage": 35.0, "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": "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": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.33, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.25, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.24, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": 3.32, "standard_charge_percentage": 83.0, "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" } ], "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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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 Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "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": "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": 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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.15, "standard_charge_percentage": 29.0, "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": 1.41, "standard_charge_percentage": 35.0, "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.01, "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": 3.2, "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": 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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.24, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.25, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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" }, { 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"standard_charge_dollar": 2.6, "standard_charge_percentage": 65.0, "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": "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.33, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "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": "outpatient", "payers_information": [ { "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.15, "standard_charge_percentage": 29.0, "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": 1.41, "standard_charge_percentage": 35.0, "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": "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": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.33, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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", "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.25, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "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": "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.24, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": 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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.15, "standard_charge_percentage": 29.0, "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": 1.41, "standard_charge_percentage": 35.0, "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": "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": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.25, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.24, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "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": "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": "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": "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": 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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.33, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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 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": "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": "Interplan", "plan_name": "PPO", "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": "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": 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": "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": "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": "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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Cigna", "plan_name": "PPO", "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": 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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.24, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.33, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.15, "standard_charge_percentage": 29.0, "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": 1.41, "standard_charge_percentage": 35.0, "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": "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": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.25, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": "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": "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": "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": "outpatient", "payers_information": [ { "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 966.63, "standard_charge_percentage": 29.0, "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": 1186.97, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "LA Care Covered CA", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1853.07, "standard_charge_percentage": 55.0, "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": "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": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1971.32, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "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": "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": "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": "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": "Monarch", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 2695.37, "standard_charge_percentage": 80.0, "methodology": "percent of total billed charges" }, { "payer_name": "Seaview IPA - 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": "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": "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": "County of Ventura", "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": "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": "LA Care DSNP", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1853.07, "standard_charge_percentage": 55.0, "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "payer_name": "Blue Shield", "plan_name": "Medicare Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1179.22, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "Private Healthcare System PHC- PPO", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2526.91, "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": 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": "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": "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": "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": "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": "LA care Medi-Cal HMO", "plan_name": "Medi-Cal HMO", "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": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1971.32, "standard_charge_percentage": 59.0, "methodology": "percent of total billed charges" }, { "payer_name": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "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": "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": "Health Care LA MediCal - RMG", "plan_name": "Medicaid Advantage", "additional_payer_notes": "N/A", "standard_charge_dollar": 1179.22, "standard_charge_percentage": 35.0, "methodology": "percent of total billed charges" }, { "payer_name": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 2806.55, "standard_charge_percentage": 83.0, "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": 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": "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": "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": "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": "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": "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": "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": "Children Hospital of Orange County", "plan_name": "Medicaid HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1347.68, "standard_charge_percentage": 40.0, "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": "Providence Healthcare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 1179.22, "standard_charge_percentage": 35.0, "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 1883.39, "standard_charge_percentage": 56.0, "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": "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": "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2526.91, "standard_charge_percentage": 75.0, "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": 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": 2358.45, "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": 2381.02, "standard_charge_percentage": 71.0, "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Health Plan of Nevada Commercial", "plan_name": "All Products", "additional_payer_notes": "N/A", "standard_charge_dollar": 2156.29, "standard_charge_percentage": 64.0, "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": 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": "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": "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": 2189.99, "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": 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": "Interplan", "plan_name": "Workman's Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1053.55, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Santa Barbara Select IPA - 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": "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": "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": "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": "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": "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": "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 Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 842.3, "standard_charge_percentage": 25.0, "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": "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": "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": "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": "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": "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" }, { "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": "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": 1347.68, "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": 2796.44, "standard_charge_percentage": 83.0, "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": "outpatient", "payers_information": [ { "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": "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": "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": "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": "First Health", "plan_name": "Workers Compensation", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.33, "standard_charge_percentage": 83.0, "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": 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": "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": 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": "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": "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": "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": "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": "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": "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": "First Health", "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": "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": "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": "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": "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": "Anthem Workers Comp", "plan_name": "Workers Comp", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.15, "standard_charge_percentage": 29.0, "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": 1.41, "standard_charge_percentage": 35.0, "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": "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": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "St. Jude", "plan_name": "Medicare HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "Health Plan of Nevada Medicare", "plan_name": "Medicare", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "Aetna", "plan_name": "Transplant", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "Delano Medical Center", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 3.0, "standard_charge_percentage": 75.0, "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": "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": "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": "Anthem Vivity, Anthem HMO", "plan_name": "HMO-City of LA", "additional_payer_notes": "N/A", "standard_charge_dollar": 1.25, "standard_charge_percentage": 31.0, "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": "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": "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": "CenCal Transplant 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": "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": "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": "Anthem Medicare", "plan_name": "Medicare", "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": "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": "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": "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": "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": "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": "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": "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": "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": "Health Net B&G", "plan_name": "HMO", "additional_payer_notes": "N/A", "standard_charge_dollar": 2.24, "standard_charge_percentage": 56.0, "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": "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": "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": "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": 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": "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": "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": "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": "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": "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": "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": "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": "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": "Interplan", "plan_name": "PPO", "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "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": "Centivo", "plan_name": "PPO", "additional_payer_notes": "N/A", "standard_charge_dollar": 0.01, "standard_charge_percentage": 100.0, "methodology": "other" }, { "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": "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": "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": "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": "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": "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": 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": "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": "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, "met