{ "hospital_name": "Willingway, Inc.", "last_updated_on": "2026-05-20", "version": "3.0.0", "location_name": [ "Willingway" ], "hospital_address": [ "311 Jones Mill Road, Statesboro, GA 30458" ], "license_information": { "state": "GA", "license_number": "016-257" }, "type_2_npi": [ "1174682546" ], "attestation": { "attestation": "To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.", "confirm_attestation": true, "attester_name": "David Gerber" }, "standard_charge_information": [ { "description": "Inpatient History and Physical", "code_information": [ { "code": "99222", "type": "CPT" }, { "code": "199222", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna", "standard_charge_dollar": 100.0, "methodology": "fee schedule" }, { 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"methodology": "fee schedule" }, { "payer_name": "Golden Rule", "plan_name": "Golden Rule", "standard_charge_dollar": 100.0, "methodology": "fee schedule" }, { "payer_name": "Healthscope/Aetna", "plan_name": "Healthscope/Aetna", "standard_charge_dollar": 100.0, "methodology": "fee schedule" }, { "payer_name": "Inetico", "plan_name": "Inetico", "standard_charge_dollar": 100.0, "methodology": "fee schedule" }, { "payer_name": "S And S Healthcare Strategies TPA", "plan_name": "S And S Healthcare Strategies TPA", "standard_charge_dollar": 100.0, "methodology": "fee schedule" }, { "payer_name": "Trustmark Health Benefits", "plan_name": "Trustmark Health Benefits", "standard_charge_dollar": 100.0, "methodology": "fee schedule" }, { "payer_name": "Valenz Access", "plan_name": "Valenz Access", "standard_charge_dollar": 100.0, "methodology": "fee schedule" } ], "minimum": 100.0, "maximum": 100.0 } ] }, { "description": "Psychotherapy w/o Medical (16-", "code_information": [ { "code": "90832", "type": "CPT" }, { "code": "190832", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna", "standard_charge_dollar": 50.0, "methodology": "fee schedule" }, { "payer_name": "AMERI HEALTH NEW JERSEY", "plan_name": "AMERI HEALTH NEW JERSEY", "standard_charge_dollar": 50.0, "methodology": "fee schedule" }, { "payer_name": "AMERICAN BEHAVIORAL BENEFIT MG", "plan_name": "AMERICAN BEHAVIORAL BENEFIT MG", "standard_charge_dollar": 50.0, "methodology": "fee schedule" }, { "payer_name": "Anthem BCBS PPO", "plan_name": "Anthem BCBS PPO", "standard_charge_dollar": 50.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Federal", "plan_name": "BCBS Federal", "standard_charge_dollar": 50.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Out Of Area", "plan_name": "BCBS Out Of Area", "standard_charge_dollar": 50.0, "methodology": "fee schedule" }, { "payer_name": "BEACON HEALTH OPTIONS", "plan_name": 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Claims", "plan_name": "Prium Worker's Comp. 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925.0, "methodology": "fee schedule" }, { "payer_name": "UHC Shared Services", "plan_name": "UHC Shared Services", "standard_charge_dollar": 925.0, "methodology": "fee schedule" }, { "payer_name": "UMR", "plan_name": "UMR", "standard_charge_dollar": 925.0, "methodology": "fee schedule" }, { "payer_name": "UNITED CLINICAL SERVICES", "plan_name": "UNITED CLINICAL SERVICES", "standard_charge_dollar": 1050.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare Student Resources", "plan_name": "United Healthcare Student Resources", "standard_charge_dollar": 830.0, "methodology": "fee schedule" }, { "payer_name": "Valenz Access", "plan_name": "Valenz Access", "standard_charge_dollar": 974.0, "methodology": "fee schedule" }, { "payer_name": "Wounded Warrior Project, Inc", "plan_name": "Wounded Warrior Project, Inc", "standard_charge_dollar": 775.0, "methodology": "fee schedule" } ], "gross_charge": 3700.0, "discounted_cash": 800.0, "minimum": 725.0, "maximum": 2000.0 } ] }, { 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775.0, "methodology": "fee schedule" }, { "payer_name": "Medica", "plan_name": "Medica", "standard_charge_dollar": 830.0, "methodology": "fee schedule" }, { "payer_name": "MEDICAL MUTUAL OF OHIO", "plan_name": "MEDICAL MUTUAL OF OHIO", "standard_charge_dollar": 775.0, "methodology": "fee schedule" }, { "payer_name": "Meritain Health", "plan_name": "Meritain Health", "standard_charge_dollar": 775.0, "methodology": "fee schedule" }, { "payer_name": "MH NET", "plan_name": "MH NET", "standard_charge_dollar": 775.0, "methodology": "fee schedule" }, { "payer_name": "North America Administrators, L.P.", "plan_name": "North America Administrators, L.P.", "standard_charge_dollar": 775.0, "methodology": "fee schedule" }, { "payer_name": "OPTUM", "plan_name": "OPTUM", "standard_charge_dollar": 925.0, "methodology": "fee schedule" }, { "payer_name": "Oxford Health Plans", "plan_name": "Oxford Health Plans", "standard_charge_dollar": 610.0, "methodology": "fee schedule" }, { "payer_name": "PCIP", "plan_name": "PCIP", "standard_charge_dollar": 775.0, "methodology": "fee schedule" }, { "payer_name": "Philadelphia American Life Insurance", "plan_name": "Philadelphia American Life Insurance", "standard_charge_dollar": 790.0, "methodology": "fee schedule" }, { "payer_name": "Piedmont Healthcare", "plan_name": "Piedmont Healthcare", "standard_charge_dollar": 669.5, "methodology": "fee schedule" }, { "payer_name": "PRIMARY PHYSICIAN CARE", "plan_name": "PRIMARY PHYSICIAN CARE", "standard_charge_dollar": 775.0, "methodology": "fee schedule" }, { "payer_name": "Prium Worker's Comp. Claims", "plan_name": "Prium Worker's Comp. Claims", "standard_charge_dollar": 775.0, "methodology": "fee schedule" }, { "payer_name": "S And S Healthcare Strategies TPA", "plan_name": "S And S Healthcare Strategies TPA", "standard_charge_dollar": 730.0, "methodology": "fee schedule" }, { "payer_name": "SECURE HEALTH", "plan_name": "SECURE HEALTH", "standard_charge_dollar": 821.93, "methodology": "fee schedule" }, { "payer_name": "Select Administrative Services Medwatch", "plan_name": "Select Administrative Services Medwatch", "standard_charge_dollar": 775.0, "methodology": "fee schedule" }, { "payer_name": "STATE FARM HEALTH", "plan_name": "STATE FARM HEALTH", "standard_charge_dollar": 775.0, "methodology": "fee schedule" }, { "payer_name": "SUPER MED", "plan_name": "SUPER MED", "standard_charge_dollar": 775.0, "methodology": "fee schedule" }, { "payer_name": "Surest", "plan_name": "Surest", "standard_charge_dollar": 830.0, "methodology": "fee schedule" }, { "payer_name": "TAYLOR BENEFIT RESOURCE", "plan_name": "TAYLOR BENEFIT RESOURCE", "standard_charge_dollar": 775.0, "methodology": "fee schedule" }, { "payer_name": "The Care Network Repricing", "plan_name": "The Care Network Repricing", "standard_charge_dollar": 755.0, "methodology": "fee schedule" }, { "payer_name": "TLC Benefit Solutions, Inc", "plan_name": "TLC Benefit Solutions, Inc", "standard_charge_dollar": 775.0, "methodology": "fee schedule" }, { "payer_name": "Trustmark Health Benefits", "plan_name": "Trustmark Health Benefits", "standard_charge_dollar": 884.0, "methodology": "fee schedule" }, { "payer_name": "UBH", "plan_name": "UBH", "standard_charge_dollar": 925.0, "methodology": "fee schedule" }, { "payer_name": "UBH/MHBP", "plan_name": "UBH/MHBP", "standard_charge_dollar": 925.0, "methodology": "fee schedule" }, { "payer_name": "UHC", "plan_name": "UHC", "standard_charge_dollar": 925.0, "methodology": "fee schedule" }, { "payer_name": "UHC Shared Services", "plan_name": "UHC Shared Services", "standard_charge_dollar": 925.0, "methodology": "fee schedule" }, { "payer_name": "UMR", "plan_name": "UMR", "standard_charge_dollar": 925.0, "methodology": "fee schedule" }, { "payer_name": "UNITED CLINICAL SERVICES", "plan_name": "UNITED CLINICAL SERVICES", "standard_charge_dollar": 775.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare Student Resources", "plan_name": "United Healthcare Student Resources", "standard_charge_dollar": 830.0, "methodology": "fee schedule" } ], "gross_charge": 3000.0, "discounted_cash": 650.0, "minimum": 610.0, "maximum": 2000.0 } ] }, { "description": "Outpatient Executive Panel", "code_information": [ { "code": "80307", "type": "CPT" }, { "code": "180303", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna", "standard_charge_dollar": 10.0, "methodology": "fee schedule" }, { "payer_name": "AMERI HEALTH NEW JERSEY", "plan_name": "AMERI HEALTH NEW JERSEY", "standard_charge_dollar": 10.0, "methodology": "fee schedule" }, { "payer_name": "AMERICAN BEHAVIORAL BENEFIT MG", "plan_name": "AMERICAN BEHAVIORAL BENEFIT MG", "standard_charge_dollar": 10.0, "methodology": "fee schedule" }, { "payer_name": "BEACON HEALTH OPTIONS", "plan_name": "BEACON HEALTH OPTIONS", "standard_charge_dollar": 10.0, "methodology": "fee schedule" }, { "payer_name": "First Health Network", "plan_name": "First Health Network", "standard_charge_dollar": 10.0, "methodology": "fee schedule" }, { "payer_name": "GEHA (Aetna Signature Admin)", "plan_name": "GEHA (Aetna Signature Admin)", "standard_charge_dollar": 10.0, "methodology": "fee schedule" }, { "payer_name": "Global Care", "plan_name": "Global Care", "standard_charge_dollar": 10.0, "methodology": "fee schedule" }, { "payer_name": "Golden Rule", "plan_name": "Golden Rule", "standard_charge_dollar": 10.0, "methodology": "fee schedule" }, { "payer_name": "Healthscope/Aetna", "plan_name": "Healthscope/Aetna", "standard_charge_dollar": 10.0, "methodology": "fee schedule" }, { "payer_name": "Inetico", "plan_name": "Inetico", "standard_charge_dollar": 10.0, "methodology": "fee schedule" }, { "payer_name": "S And S Healthcare Strategies TPA", "plan_name": "S And S Healthcare Strategies TPA", "standard_charge_dollar": 10.0, "methodology": "fee schedule" }, { "payer_name": "Trustmark Health Benefits", "plan_name": "Trustmark Health Benefits", "standard_charge_dollar": 10.0, "methodology": "fee schedule" }, { "payer_name": "Valenz Access", "plan_name": "Valenz Access", "standard_charge_dollar": 10.0, "methodology": "fee schedule" } ], "gross_charge": 150.0, "minimum": 10.0, "maximum": 10.0 } ] }, { "description": "PHP BOARDING", "code_information": [ { "code": "342000", "type": "RC" }, { "code": "342000", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna", "standard_charge_dollar": 643.0, "methodology": "fee schedule" }, { "payer_name": "Assured Benefit Administrators", "plan_name": "Assured Benefit Administrators", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "Bind Benefits", "plan_name": "Bind Benefits", "standard_charge_dollar": 294.0, "methodology": "fee schedule" }, { "payer_name": "EBMS Employee Benefit Management Service", "plan_name": "EBMS Employee Benefit Management Service", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "GEHA (Aetna Signature Admin)", "plan_name": "GEHA (Aetna Signature Admin)", "standard_charge_dollar": 643.0, "methodology": "fee schedule" }, { "payer_name": "Golden Rule", "plan_name": "Golden Rule", "standard_charge_dollar": 316.0, "methodology": "fee schedule" }, { "payer_name": "Healthscope/Aetna", "plan_name": "Healthscope/Aetna", "standard_charge_dollar": 643.0, "methodology": "fee schedule" }, { "payer_name": "OPTUM", "plan_name": "OPTUM", "standard_charge_dollar": 434.0, "methodology": "fee schedule" }, { "payer_name": "Optum VACCN", "plan_name": "Optum VACCN", "standard_charge_dollar": 565.82, "methodology": "fee schedule" }, { "payer_name": "Philadelphia American Life Insurance", "plan_name": "Philadelphia American Life Insurance", "standard_charge_dollar": 316.0, "methodology": "fee schedule" }, { "payer_name": "Piedmont Healthcare", "plan_name": "Piedmont Healthcare", "standard_charge_dollar": 316.0, "methodology": "fee schedule" }, { "payer_name": "Surest", "plan_name": "Surest", "standard_charge_dollar": 332.0, "methodology": "fee schedule" }, { "payer_name": "Tricare East", "plan_name": "Tricare East", "standard_charge_dollar": 424.16, "methodology": "fee schedule" }, { "payer_name": "Trustmark Health Benefits", "plan_name": "Trustmark Health Benefits", "standard_charge_dollar": 643.0, "methodology": "fee schedule" }, { "payer_name": "UBH", "plan_name": "UBH", "standard_charge_dollar": 434.0, "methodology": "fee schedule" }, { "payer_name": "UBH/MHBP", "plan_name": "UBH/MHBP", "standard_charge_dollar": 434.0, "methodology": "fee schedule" }, { "payer_name": "UHC", "plan_name": "UHC", "standard_charge_dollar": 434.0, "methodology": "fee schedule" }, { "payer_name": "UHC Shared Services", "plan_name": "UHC Shared Services", "standard_charge_dollar": 434.0, "methodology": "fee schedule" }, { "payer_name": "UMR", "plan_name": "UMR", "standard_charge_dollar": 434.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare Student Resources", "plan_name": "United Healthcare Student Resources", "standard_charge_dollar": 332.0, "methodology": "fee schedule" } ], "discounted_cash": 550.0, "minimum": 294.0, "maximum": 643.0 } ] }, { "description": "IOP", "code_information": [ { "code": "351000", "type": "RC" }, { "code": "351000", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna", "standard_charge_dollar": 205.0, "methodology": "fee schedule" }, { "payer_name": "Healthscope/Aetna", "plan_name": "Healthscope/Aetna", "standard_charge_dollar": 171.0, "methodology": "fee schedule" }, { "payer_name": "Trustmark Health Benefits", "plan_name": "Trustmark Health Benefits", "standard_charge_dollar": 171.0, "methodology": "fee schedule" } ], "minimum": 171.0, "maximum": 205.0 } ] }, { "description": "IOP BOARDING", "code_information": [ { "code": "352000", "type": "RC" }, { "code": "352000", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna", "standard_charge_dollar": 205.0, "methodology": "fee schedule" }, { "payer_name": "Assured Benefit Administrators", "plan_name": "Assured Benefit Administrators", "standard_charge_dollar": 150.0, "methodology": "fee schedule" }, { "payer_name": "Bind Benefits", "plan_name": "Bind Benefits", "standard_charge_dollar": 121.0, "methodology": "fee schedule" }, { "payer_name": "EBMS Employee Benefit Management Service", "plan_name": "EBMS Employee Benefit Management Service", "standard_charge_dollar": 150.0, "methodology": "fee schedule" }, { "payer_name": "GEHA (Aetna Signature Admin)", "plan_name": "GEHA (Aetna Signature Admin)", "standard_charge_dollar": 177.0, "methodology": "fee schedule" }, { "payer_name": "Golden Rule", "plan_name": "Golden Rule", "standard_charge_dollar": 128.0, "methodology": "fee schedule" }, { "payer_name": "Healthscope/Aetna", "plan_name": "Healthscope/Aetna", "standard_charge_dollar": 177.0, "methodology": "fee schedule" }, { "payer_name": "OPTUM", "plan_name": "OPTUM", "standard_charge_dollar": 278.0, "methodology": "fee schedule" }, { "payer_name": "Philadelphia American Life Insurance", "plan_name": "Philadelphia American Life Insurance", "standard_charge_dollar": 128.0, "methodology": "fee schedule" }, { "payer_name": "Piedmont Healthcare", "plan_name": "Piedmont Healthcare", "standard_charge_dollar": 128.0, "methodology": "fee schedule" }, { "payer_name": "Surest", "plan_name": "Surest", "standard_charge_dollar": 231.0, "methodology": "fee schedule" }, { "payer_name": "Trustmark Health Benefits", "plan_name": "Trustmark Health Benefits", "standard_charge_dollar": 177.0, "methodology": "fee schedule" }, { "payer_name": "UBH", "plan_name": "UBH", "standard_charge_dollar": 278.0, "methodology": "fee schedule" }, { "payer_name": "UBH/MHBP", "plan_name": "UBH/MHBP", "standard_charge_dollar": 278.0, "methodology": "fee schedule" }, { "payer_name": "UHC", "plan_name": "UHC", "standard_charge_dollar": 278.0, "methodology": "fee schedule" }, { "payer_name": "UHC Shared Services", "plan_name": "UHC Shared Services", "standard_charge_dollar": 278.0, "methodology": "fee schedule" }, { "payer_name": "UMR", "plan_name": "UMR", "standard_charge_dollar": 278.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare Student Resources", "plan_name": "United Healthcare Student Resources", "standard_charge_dollar": 231.0, "methodology": "fee schedule" } ], "discounted_cash": 75.0, "minimum": 121.0, "maximum": 278.0 } ] }, { "description": "IOP - TELEHEALTH", "code_information": [ { "code": "H0015", "type": "HCPCS" }, { "code": "353", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Alliant Health Plans", "plan_name": "Alliant Health Plans", "standard_charge_dollar": 174.4, "methodology": "fee schedule" }, { "payer_name": "Ambetter Of Arkansas", "plan_name": "Ambetter Of Arkansas", "standard_charge_dollar": 250.0, "methodology": "fee schedule" }, { "payer_name": "Ambetter-Sunshine State", "plan_name": "Ambetter-Sunshine State", "standard_charge_dollar": 183.0, "methodology": "fee schedule" }, { "payer_name": "AMERI HEALTH NEW JERSEY", "plan_name": "AMERI HEALTH NEW JERSEY", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "Anthem BCBS HMO", "plan_name": "Anthem BCBS HMO", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "Anthem BCBS Pathways", "plan_name": "Anthem BCBS Pathways", "standard_charge_dollar": 268.0, "methodology": "fee schedule" }, { "payer_name": "Anthem BCBS PPO", "plan_name": "Anthem BCBS PPO", "standard_charge_dollar": 309.0, "methodology": "fee schedule" }, { "payer_name": "Anthem Blue Value", "plan_name": "Anthem Blue Value", "standard_charge_dollar": 260.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Federal", "plan_name": "BCBS Federal", "standard_charge_dollar": 260.66, "methodology": "fee schedule" }, { "payer_name": "BCBS Of FL- Florida Blue", "plan_name": "BCBS Of FL- Florida Blue", "standard_charge_dollar": 250.0, "methodology": "fee schedule" }, { "payer_name": "BEACON HEALTH OPTIONS", "plan_name": "BEACON HEALTH OPTIONS", "standard_charge_dollar": 175.0, "methodology": "fee schedule" }, { "payer_name": "Benefit Plan Administrators", "plan_name": "Benefit Plan Administrators", "standard_charge_dollar": 200.0, "methodology": "fee schedule" }, { "payer_name": "Benefits Support IN", "plan_name": "Benefits Support IN", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "CAMERON & ASSOCIATES", "plan_name": "CAMERON & ASSOCIATES", "standard_charge_dollar": 125.0, "methodology": "fee schedule" }, { "payer_name": "Carelon Behavioral Health", "plan_name": "Carelon Behavioral Health", "standard_charge_dollar": 200.0, "methodology": "fee schedule" }, { "payer_name": "CareSource", "plan_name": "CareSource", "standard_charge_dollar": 200.0, "methodology": "fee schedule" }, { "payer_name": "Cigna", "plan_name": "Cigna", "standard_charge_dollar": 151.0, "methodology": "fee schedule" }, { "payer_name": "CIGNA-JAX", "plan_name": "CIGNA-JAX", "standard_charge_dollar": 225.0, "methodology": "fee schedule" }, { "payer_name": "COMPSYCH", "plan_name": "COMPSYCH", "standard_charge_dollar": 139.0, "methodology": "fee schedule" }, { "payer_name": "CONSUMER LIFE INSURANCE CO", "plan_name": "CONSUMER LIFE INSURANCE CO", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "CORE ADMINSTRATIVE SERVICES", "plan_name": "CORE ADMINSTRATIVE SERVICES", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "Core Benefits Inc", "plan_name": "Core Benefits Inc", "standard_charge_dollar": 880.0, "methodology": "fee schedule" }, { "payer_name": "CORE SOURCE", "plan_name": "CORE SOURCE", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "Coventry Health Care Of GA", "plan_name": "Coventry Health Care Of GA", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "Curative Health", "plan_name": "Curative Health", "standard_charge_dollar": 330.0, "methodology": "fee schedule" }, { "payer_name": "DEVON HEALTH REPRICING", "plan_name": "DEVON HEALTH REPRICING", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "First Health Network", "plan_name": "First Health Network", "standard_charge_dollar": 254.0, "methodology": "fee schedule" }, { "payer_name": "GEHA (Aetna Signature Admin)", "plan_name": "GEHA (Aetna Signature Admin)", "standard_charge_dollar": 157.0, "methodology": "fee schedule" }, { "payer_name": "Geisinger Health Plan", "plan_name": "Geisinger Health Plan", "standard_charge_dollar": 880.0, "methodology": "fee schedule" }, { "payer_name": "Global Care", "plan_name": "Global Care", "standard_charge_dollar": 138.0, "methodology": "fee schedule" }, { "payer_name": "Golden Rule", "plan_name": "Golden Rule", "standard_charge_dollar": 128.0, "methodology": "fee schedule" }, { "payer_name": "GROUP HEALTH COOPERATIVE", "plan_name": "GROUP HEALTH COOPERATIVE", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "HEALTHGRAM", "plan_name": "HEALTHGRAM", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "Humana", "plan_name": "Humana", "standard_charge_dollar": 225.0, "methodology": "fee schedule" }, { "payer_name": "Inetico", "plan_name": "Inetico", "standard_charge_dollar": 138.0, "methodology": "fee schedule" }, { "payer_name": "Insurance TPA -Life Shield", "plan_name": "Insurance TPA -Life Shield", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "Maestro Health", "plan_name": "Maestro Health", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "MAGELLAN HEALTH SERVICES", "plan_name": "MAGELLAN HEALTH SERVICES", "standard_charge_dollar": 151.0, "methodology": "fee schedule" }, { "payer_name": "MAILHANDLERS BENEFIT PLAN", "plan_name": "MAILHANDLERS BENEFIT PLAN", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "MedCost Benefit Services", "plan_name": "MedCost Benefit Services", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "Medica", "plan_name": "Medica", "standard_charge_dollar": 220.0, "methodology": "fee schedule" }, { "payer_name": "MEDICAL MUTUAL OF OHIO", "plan_name": "MEDICAL MUTUAL OF OHIO", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "Meritain Health", "plan_name": "Meritain Health", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "MH NET", "plan_name": "MH NET", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "OPTUM", "plan_name": "OPTUM", "standard_charge_dollar": 278.0, "methodology": "fee schedule" }, { "payer_name": "Optum VACCN", "plan_name": "Optum VACCN", "standard_charge_dollar": 294.88, "methodology": "fee schedule" }, { "payer_name": "Oxford Health Plans", "plan_name": "Oxford Health Plans", "standard_charge_dollar": 239.0, "methodology": "fee schedule" }, { "payer_name": "PCIP", "plan_name": "PCIP", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "Philadelphia American Life Insurance", "plan_name": "Philadelphia American Life Insurance", "standard_charge_dollar": 128.0, "methodology": "fee schedule" }, { "payer_name": "Piedmont Healthcare", "plan_name": "Piedmont Healthcare", "standard_charge_dollar": 231.75, "methodology": "fee schedule" }, { "payer_name": "PRIMARY PHYSICIAN CARE", "plan_name": "PRIMARY PHYSICIAN CARE", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "Prium Worker's Comp. Claims", "plan_name": "Prium Worker's Comp. Claims", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "SECURE HEALTH", "plan_name": "SECURE HEALTH", "standard_charge_dollar": 158.82, "methodology": "fee schedule" }, { "payer_name": "Select Administrative Services Medwatch", "plan_name": "Select Administrative Services Medwatch", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "STATE FARM HEALTH", "plan_name": "STATE FARM HEALTH", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "SUPER MED", "plan_name": "SUPER MED", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "Surest", "plan_name": "Surest", "standard_charge_dollar": 220.0, "methodology": "fee schedule" }, { "payer_name": "TAYLOR BENEFIT RESOURCE", "plan_name": "TAYLOR BENEFIT RESOURCE", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "The Care Network Repricing", "plan_name": "The Care Network Repricing", "standard_charge_dollar": 170.0, "methodology": "fee schedule" }, { "payer_name": "TLC Benefit Solutions, Inc", "plan_name": "TLC Benefit Solutions, Inc", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "Tricare East", "plan_name": "Tricare East", "standard_charge_dollar": 296.84, "methodology": "fee schedule" }, { "payer_name": "UBH", "plan_name": "UBH", "standard_charge_dollar": 278.0, "methodology": "fee schedule" }, { "payer_name": "UBH/MHBP", "plan_name": "UBH/MHBP", "standard_charge_dollar": 278.0, "methodology": "fee schedule" }, { "payer_name": "UHC", "plan_name": "UHC", "standard_charge_dollar": 278.0, "methodology": "fee schedule" }, { "payer_name": "UHC Shared Services", "plan_name": "UHC Shared Services", "standard_charge_dollar": 278.0, "methodology": "fee schedule" }, { "payer_name": "UMR", "plan_name": "UMR", "standard_charge_dollar": 278.0, "methodology": "fee schedule" }, { "payer_name": "UNITED CLINICAL SERVICES", "plan_name": "UNITED CLINICAL SERVICES", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare Student Resources", "plan_name": "United Healthcare Student Resources", "standard_charge_dollar": 220.0, "methodology": "fee schedule" }, { "payer_name": "Valenz Access", "plan_name": "Valenz Access", "standard_charge_dollar": 254.0, "methodology": "fee schedule" }, { "payer_name": "Value Options", "plan_name": "Value Options", "standard_charge_dollar": 130.0, "methodology": "fee schedule" } ], "gross_charge": 1700.0, "discounted_cash": 75.0, "minimum": 125.0, "maximum": 880.0 } ] }, { "description": "IOP CD", "code_information": [ { "code": "H0015", "type": "HCPCS" }, { "code": "354000", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna", "standard_charge_dollar": 171.0, "methodology": "fee schedule" }, { "payer_name": "All Savers Insurance - UHC", "plan_name": "All Savers Insurance - UHC", "standard_charge_dollar": 128.0, "methodology": "fee schedule" }, { "payer_name": "Alliant Health Plans", "plan_name": "Alliant Health Plans", "standard_charge_dollar": 174.4, "methodology": "fee schedule" }, { "payer_name": "Ambetter Of Arkansas", "plan_name": "Ambetter Of Arkansas", "standard_charge_dollar": 250.0, "methodology": "fee schedule" }, { "payer_name": "Ambetter-Sunshine State", "plan_name": "Ambetter-Sunshine State", "standard_charge_dollar": 183.0, "methodology": "fee schedule" }, { "payer_name": "AMERI HEALTH NEW JERSEY", "plan_name": "AMERI HEALTH NEW JERSEY", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "AMERICAN BEHAVIORAL BENEFIT MG", "plan_name": "AMERICAN BEHAVIORAL BENEFIT MG", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "Anthem BCBS HMO", "plan_name": "Anthem BCBS HMO", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "Anthem BCBS Pathways", "plan_name": "Anthem BCBS Pathways", "standard_charge_dollar": 268.0, "methodology": "fee schedule" }, { "payer_name": "Anthem BCBS PPO", "plan_name": "Anthem BCBS PPO", "standard_charge_dollar": 309.0, "methodology": "fee schedule" }, { "payer_name": "Anthem Blue Value", "plan_name": "Anthem Blue Value", "standard_charge_dollar": 260.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Federal", "plan_name": "BCBS Federal", "standard_charge_dollar": 309.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Of FL- Florida Blue", "plan_name": "BCBS Of FL- Florida Blue", "standard_charge_dollar": 250.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Out Of Area", "plan_name": "BCBS Out Of Area", "standard_charge_dollar": 260.66, "methodology": "fee schedule" }, { "payer_name": "BEACON HEALTH OPTIONS", "plan_name": "BEACON HEALTH OPTIONS", "standard_charge_dollar": 179.0, "methodology": "fee schedule" }, { "payer_name": "Benefit Plan Administrators", "plan_name": "Benefit Plan Administrators", "standard_charge_dollar": 200.0, "methodology": "fee schedule" }, { "payer_name": "Benefits Support IN", "plan_name": "Benefits Support IN", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "Bright Health Commercial", "plan_name": "Bright Health Commercial", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "CAMERON & ASSOCIATES", "plan_name": "CAMERON & ASSOCIATES", "standard_charge_dollar": 125.0, "methodology": "fee schedule" }, { "payer_name": "Carelon Behavioral Health", "plan_name": "Carelon Behavioral Health", "standard_charge_dollar": 200.0, "methodology": "fee schedule" }, { "payer_name": "CareSource", "plan_name": "CareSource", "standard_charge_dollar": 200.0, "methodology": "fee schedule" }, { "payer_name": "Cigna", "plan_name": "Cigna", "standard_charge_dollar": 151.0, "methodology": "fee schedule" }, { "payer_name": "CIGNA-JAX", "plan_name": "CIGNA-JAX", "standard_charge_dollar": 225.0, "methodology": "fee schedule" }, { "payer_name": "COMPSYCH", "plan_name": "COMPSYCH", "standard_charge_dollar": 139.0, "methodology": "fee schedule" }, { "payer_name": "CONSUMER LIFE INSURANCE CO", "plan_name": "CONSUMER LIFE INSURANCE CO", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "CORE ADMINSTRATIVE SERVICES", "plan_name": "CORE ADMINSTRATIVE SERVICES", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "Core Benefits Inc", "plan_name": "Core Benefits Inc", "standard_charge_dollar": 880.0, "methodology": "fee schedule" }, { "payer_name": "CORE SOURCE", "plan_name": "CORE SOURCE", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "Coventry Health Care Of GA", "plan_name": "Coventry Health Care Of GA", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "Curative Health", "plan_name": "Curative Health", "standard_charge_dollar": 330.0, "methodology": "fee schedule" }, { "payer_name": "DEVON HEALTH REPRICING", "plan_name": "DEVON HEALTH REPRICING", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "First Health Network", "plan_name": "First Health Network", "standard_charge_dollar": 254.0, "methodology": "fee schedule" }, { "payer_name": "Friday Health Plan", "plan_name": "Friday Health Plan", "standard_charge_dollar": 250.0, "methodology": "fee schedule" }, { "payer_name": "GEHA (Aetna Signature Admin)", "plan_name": "GEHA (Aetna Signature Admin)", "standard_charge_dollar": 157.0, "methodology": "fee schedule" }, { "payer_name": "Geisinger Health Plan", "plan_name": "Geisinger Health Plan", "standard_charge_dollar": 880.0, "methodology": "fee schedule" }, { "payer_name": "Global Care", "plan_name": "Global Care", "standard_charge_dollar": 138.0, "methodology": "fee schedule" }, { "payer_name": "Golden Rule", "plan_name": "Golden Rule", "standard_charge_dollar": 128.0, "methodology": "fee schedule" }, { "payer_name": "GROUP HEALTH COOPERATIVE", "plan_name": "GROUP HEALTH COOPERATIVE", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "HEALTHGRAM", "plan_name": "HEALTHGRAM", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "Healthscope/Aetna", "plan_name": "Healthscope/Aetna", "standard_charge_dollar": 171.0, "methodology": "fee schedule" }, { "payer_name": "Humana", "plan_name": "Humana", "standard_charge_dollar": 225.0, "methodology": "fee schedule" }, { "payer_name": "Industry Buying Group", "plan_name": "Industry Buying Group", "standard_charge_dollar": 280.0, "methodology": "fee schedule" }, { "payer_name": "Inetico", "plan_name": "Inetico", "standard_charge_dollar": 138.0, "methodology": "fee schedule" }, { "payer_name": "Insurance TPA -Life Shield", "plan_name": "Insurance TPA -Life Shield", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "Maestro Health", "plan_name": "Maestro Health", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "MAGELLAN HEALTH SERVICES", "plan_name": "MAGELLAN HEALTH SERVICES", "standard_charge_dollar": 151.0, "methodology": "fee schedule" }, { "payer_name": "MAILHANDLERS BENEFIT PLAN", "plan_name": "MAILHANDLERS BENEFIT PLAN", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "MedCost Benefit Services", "plan_name": "MedCost Benefit Services", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "Medica", "plan_name": "Medica", "standard_charge_dollar": 220.0, "methodology": "fee schedule" }, { "payer_name": "MEDICAL MUTUAL OF OHIO", "plan_name": "MEDICAL MUTUAL OF OHIO", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "Meritain Health", "plan_name": "Meritain Health", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "MH NET", "plan_name": "MH NET", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "North America Administrators, L.P.", "plan_name": "North America Administrators, L.P.", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "OPTUM", "plan_name": "OPTUM", "standard_charge_dollar": 278.0, "methodology": "fee schedule" }, { "payer_name": "Optum VACCN", "plan_name": "Optum VACCN", "standard_charge_dollar": 294.88, "methodology": "fee schedule" }, { "payer_name": "Oxford Health Plans", "plan_name": "Oxford Health Plans", "standard_charge_dollar": 239.0, "methodology": "fee schedule" }, { "payer_name": "PCIP", "plan_name": "PCIP", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "Philadelphia American Life Insurance", "plan_name": "Philadelphia American Life Insurance", "standard_charge_dollar": 128.0, "methodology": "fee schedule" }, { "payer_name": "Piedmont Healthcare", "plan_name": "Piedmont Healthcare", "standard_charge_dollar": 231.75, "methodology": "fee schedule" }, { "payer_name": "PRIMARY PHYSICIAN CARE", "plan_name": "PRIMARY PHYSICIAN CARE", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "Prium Worker's Comp. Claims", "plan_name": "Prium Worker's Comp. Claims", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America", "standard_charge_dollar": 310.0, "methodology": "fee schedule" }, { "payer_name": "S And S Healthcare Strategies TPA", "plan_name": "S And S Healthcare Strategies TPA", "standard_charge_dollar": 145.0, "methodology": "fee schedule" }, { "payer_name": "SECURE HEALTH", "plan_name": "SECURE HEALTH", "standard_charge_dollar": 158.82, "methodology": "fee schedule" }, { "payer_name": "Select Administrative Services Medwatch", "plan_name": "Select Administrative Services Medwatch", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "STATE FARM HEALTH", "plan_name": "STATE FARM HEALTH", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "SUPER MED", "plan_name": "SUPER MED", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "Surest", "plan_name": "Surest", "standard_charge_dollar": 220.0, "methodology": "fee schedule" }, { "payer_name": "TAYLOR BENEFIT RESOURCE", "plan_name": "TAYLOR BENEFIT RESOURCE", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "The Care Network Repricing", "plan_name": "The Care Network Repricing", "standard_charge_dollar": 170.0, "methodology": "fee schedule" }, { "payer_name": "TLC Benefit Solutions, Inc", "plan_name": "TLC Benefit Solutions, Inc", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "Tricare East", "plan_name": "Tricare East", "standard_charge_dollar": 318.56, "methodology": "fee schedule" }, { "payer_name": "Trustmark Health Benefits", "plan_name": "Trustmark Health Benefits", "standard_charge_dollar": 171.0, "methodology": "fee schedule" }, { "payer_name": "UBH", "plan_name": "UBH", "standard_charge_dollar": 278.0, "methodology": "fee schedule" }, { "payer_name": "UBH/MHBP", "plan_name": "UBH/MHBP", "standard_charge_dollar": 278.0, "methodology": "fee schedule" }, { "payer_name": "UHC", "plan_name": "UHC", "standard_charge_dollar": 278.0, "methodology": "fee schedule" }, { "payer_name": "UHC Shared Services", "plan_name": "UHC Shared Services", "standard_charge_dollar": 278.0, "methodology": "fee schedule" }, { "payer_name": "UMR", "plan_name": "UMR", "standard_charge_dollar": 278.0, "methodology": "fee schedule" }, { "payer_name": "UNITED CLINICAL SERVICES", "plan_name": "UNITED CLINICAL SERVICES", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare Student Resources", "plan_name": "United Healthcare Student Resources", "standard_charge_dollar": 220.0, "methodology": "fee schedule" }, { "payer_name": "Valenz Access", "plan_name": "Valenz Access", "standard_charge_dollar": 254.0, "methodology": "fee schedule" } ], "gross_charge": 1700.0, "discounted_cash": 75.0, "minimum": 125.0, "maximum": 880.0 } ] }, { "description": "IOP CD W/BOARDING", "code_information": [ { "code": "H0015", "type": "HCPCS" }, { "code": "352", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna", "standard_charge_dollar": 177.0, "methodology": "fee schedule" }, { "payer_name": "All Savers Insurance - UHC", "plan_name": "All Savers Insurance - UHC", "standard_charge_dollar": 128.0, "methodology": "fee schedule" }, { "payer_name": "Alliant Health Plans", "plan_name": "Alliant Health Plans", "standard_charge_dollar": 174.4, "methodology": "fee schedule" }, { "payer_name": "ALLIED BENEFITS SYSTEM, INC", "plan_name": "ALLIED BENEFITS SYSTEM, INC", "standard_charge_dollar": 157.0, "methodology": "fee schedule" }, { "payer_name": "Ambetter-Sunshine State", "plan_name": "Ambetter-Sunshine State", "standard_charge_dollar": 183.0, "methodology": "fee schedule" }, { "payer_name": "Anthem BCBS HMO", "plan_name": "Anthem BCBS HMO", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "Anthem BCBS Pathways", "plan_name": "Anthem BCBS Pathways", "standard_charge_dollar": 268.0, "methodology": "fee schedule" }, { "payer_name": "Anthem BCBS PPO", "plan_name": "Anthem BCBS PPO", "standard_charge_dollar": 309.0, "methodology": "fee schedule" }, { "payer_name": "Anthem Blue Value", "plan_name": "Anthem Blue Value", "standard_charge_dollar": 260.0, "methodology": "fee schedule" }, { "payer_name": "Assured Benefit Administrators", "plan_name": "Assured Benefit Administrators", "standard_charge_dollar": 150.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Federal", "plan_name": "BCBS Federal", "standard_charge_dollar": 309.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Of FL- Florida Blue", "plan_name": "BCBS Of FL- Florida Blue", "standard_charge_dollar": 250.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Out Of Area", "plan_name": "BCBS Out Of Area", "standard_charge_dollar": 260.66, "methodology": "fee schedule" }, { "payer_name": "BEACON HEALTH OPTIONS", "plan_name": "BEACON HEALTH OPTIONS", "standard_charge_dollar": 179.0, "methodology": "fee schedule" }, { "payer_name": "Benefit Plan Administrators", "plan_name": "Benefit Plan Administrators", "standard_charge_dollar": 200.0, "methodology": "fee schedule" }, { "payer_name": "Bind Benefits", "plan_name": "Bind Benefits", "standard_charge_dollar": 121.0, "methodology": "fee schedule" }, { "payer_name": "Bright Health Commercial", "plan_name": "Bright Health Commercial", "standard_charge_dollar": 1250.0, "methodology": "fee schedule" }, { "payer_name": "Carelon Behavioral Health", "plan_name": "Carelon Behavioral Health", "standard_charge_dollar": 200.0, "methodology": "fee schedule" }, { "payer_name": "CareSource", "plan_name": "CareSource", "standard_charge_dollar": 200.0, "methodology": "fee schedule" }, { "payer_name": "Cigna", "plan_name": "Cigna", "standard_charge_dollar": 151.0, "methodology": "fee schedule" }, { "payer_name": "CIGNA-JAX", "plan_name": "CIGNA-JAX", "standard_charge_dollar": 225.0, "methodology": "fee schedule" }, { "payer_name": "Core Benefits Inc", "plan_name": "Core Benefits Inc", "standard_charge_dollar": 880.0, "methodology": "fee schedule" }, { "payer_name": "Curative Health", "plan_name": "Curative Health", "standard_charge_dollar": 330.0, "methodology": "fee schedule" }, { "payer_name": "EBMS Employee Benefit Management Service", "plan_name": "EBMS Employee Benefit Management Service", "standard_charge_dollar": 150.0, "methodology": "fee schedule" }, { "payer_name": "GEHA (Aetna Signature Admin)", "plan_name": "GEHA (Aetna Signature Admin)", "standard_charge_dollar": 177.0, "methodology": "fee schedule" }, { "payer_name": "Geisinger Health Plan", "plan_name": "Geisinger Health Plan", "standard_charge_dollar": 880.0, "methodology": "fee schedule" }, { "payer_name": "Healthscope/Aetna", "plan_name": "Healthscope/Aetna", "standard_charge_dollar": 177.0, "methodology": "fee schedule" }, { "payer_name": "Humana", "plan_name": "Humana", "standard_charge_dollar": 225.0, "methodology": "fee schedule" }, { "payer_name": "MAGELLAN HEALTH SERVICES", "plan_name": "MAGELLAN HEALTH SERVICES", "standard_charge_dollar": 151.0, "methodology": "fee schedule" }, { "payer_name": "North America Administrators, L.P.", "plan_name": "North America Administrators, L.P.", "standard_charge_dollar": 300.0, "methodology": "fee schedule" }, { "payer_name": "OPTUM", "plan_name": "OPTUM", "standard_charge_dollar": 121.0, "methodology": "fee schedule" }, { "payer_name": "Oxford Health Plans", "plan_name": "Oxford Health Plans", "standard_charge_dollar": 239.0, "methodology": "fee schedule" }, { "payer_name": "Philadelphia American Life Insurance", "plan_name": "Philadelphia American Life Insurance", "standard_charge_dollar": 231.75, "methodology": "fee schedule" }, { "payer_name": "Piedmont Healthcare", "plan_name": "Piedmont Healthcare", "standard_charge_dollar": 231.75, "methodology": "fee schedule" }, { "payer_name": "SECURE HEALTH", "plan_name": "SECURE HEALTH", "standard_charge_dollar": 158.82, "methodology": "fee schedule" }, { "payer_name": "Trustmark Health Benefits", "plan_name": "Trustmark Health Benefits", "standard_charge_dollar": 177.0, "methodology": "fee schedule" }, { "payer_name": "UBH/MHBP", "plan_name": "UBH/MHBP", "standard_charge_dollar": 1600.0, "methodology": "fee schedule" } ], "gross_charge": 1700.0, "discounted_cash": 75.0, "minimum": 121.0, "maximum": 1600.0 } ] }, { "description": "IOP-TELEHEALTH", "code_information": [ { "code": "H0015", "type": "HCPCS" }, { "code": "378000", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "OPTUM", "plan_name": "OPTUM", "standard_charge_dollar": 253.0, "methodology": "fee schedule" }, { "payer_name": "Tricare East", "plan_name": "Tricare East", "standard_charge_dollar": 318.56, "methodology": "fee schedule" }, { "payer_name": "UBH", "plan_name": "UBH", "standard_charge_dollar": 253.0, "methodology": "fee schedule" }, { "payer_name": "UHC", "plan_name": "UHC", "standard_charge_dollar": 253.0, "methodology": "fee schedule" }, { "payer_name": "UHC Shared Services", "plan_name": "UHC Shared Services", "standard_charge_dollar": 253.0, "methodology": "fee schedule" }, { "payer_name": "UMR", "plan_name": "UMR", "standard_charge_dollar": 253.0, "methodology": "fee schedule" } ], "gross_charge": 1700.0, "discounted_cash": 75.0, "minimum": 253.0, "maximum": 318.56 } ] }, { "description": "PHP", "code_information": [ { "code": "H0035", "type": "HCPCS" }, { "code": "341", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna", "standard_charge_dollar": 643.0, "methodology": "fee schedule" }, { "payer_name": "All Savers Insurance - UHC", "plan_name": "All Savers Insurance - UHC", "standard_charge_dollar": 310.0, "methodology": "fee schedule" }, { "payer_name": "Alliant Health Plans", "plan_name": "Alliant Health Plans", "standard_charge_dollar": 400.29, "methodology": "fee schedule" }, { "payer_name": "Ambetter-Sunshine State", "plan_name": "Ambetter-Sunshine State", "standard_charge_dollar": 411.0, "methodology": "fee schedule" }, { "payer_name": "AMERI HEALTH NEW JERSEY", "plan_name": "AMERI HEALTH NEW JERSEY", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "AMERICAN BEHAVIORAL BENEFIT MG", "plan_name": "AMERICAN BEHAVIORAL BENEFIT MG", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "Anthem BCBS HMO", "plan_name": "Anthem BCBS HMO", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Anthem BCBS Pathways", "plan_name": "Anthem BCBS Pathways", "standard_charge_dollar": 477.0, "methodology": "fee schedule" }, { "payer_name": "Anthem BCBS PPO", "plan_name": "Anthem BCBS PPO", "standard_charge_dollar": 477.3, "methodology": "fee schedule" }, { "payer_name": "Anthem Blue Value", "plan_name": "Anthem Blue Value", "standard_charge_dollar": 440.0, "methodology": "fee schedule" }, { "payer_name": "BEACON HEALTH OPTIONS", "plan_name": "BEACON HEALTH OPTIONS", "standard_charge_dollar": 554.0, "methodology": "fee schedule" }, { "payer_name": "Benefits Support IN", "plan_name": "Benefits Support IN", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "Bright Health Commercial", "plan_name": "Bright Health Commercial", "standard_charge_dollar": 550.0, "methodology": "fee schedule" }, { "payer_name": "CAMERON & ASSOCIATES", "plan_name": "CAMERON & ASSOCIATES", "standard_charge_dollar": 125.0, "methodology": "fee schedule" }, { "payer_name": "CareSource", "plan_name": "CareSource", "standard_charge_dollar": 380.0, "methodology": "fee schedule" }, { "payer_name": "Cigna", "plan_name": "Cigna", "standard_charge_dollar": 555.0, "methodology": "fee schedule" }, { "payer_name": "COMPSYCH", "plan_name": "COMPSYCH", "standard_charge_dollar": 468.0, "methodology": "fee schedule" }, { "payer_name": "CONSUMER LIFE INSURANCE CO", "plan_name": "CONSUMER LIFE INSURANCE CO", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "CORE ADMINSTRATIVE SERVICES", "plan_name": "CORE ADMINSTRATIVE SERVICES", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "Core Benefits Inc", "plan_name": "Core Benefits Inc", "standard_charge_dollar": 1360.0, "methodology": "fee schedule" }, { "payer_name": "CORE SOURCE", "plan_name": "CORE SOURCE", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "Coventry Health Care Of GA", "plan_name": "Coventry Health Care Of GA", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "Curative Health", "plan_name": "Curative Health", "standard_charge_dollar": 465.0, "methodology": "fee schedule" }, { "payer_name": "DEVON HEALTH REPRICING", "plan_name": "DEVON HEALTH REPRICING", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "First Health Network", "plan_name": "First Health Network", "standard_charge_dollar": 607.0, "methodology": "fee schedule" }, { "payer_name": "GEHA (Aetna Signature Admin)", "plan_name": "GEHA (Aetna Signature Admin)", "standard_charge_dollar": 573.0, "methodology": "fee schedule" }, { "payer_name": "Geisinger Health Plan", "plan_name": "Geisinger Health Plan", "standard_charge_dollar": 1360.0, "methodology": "fee schedule" }, { "payer_name": "Global Care", "plan_name": "Global Care", "standard_charge_dollar": 507.0, "methodology": "fee schedule" }, { "payer_name": "Golden Rule", "plan_name": "Golden Rule", "standard_charge_dollar": 310.0, "methodology": "fee schedule" }, { "payer_name": "GROUP HEALTH COOPERATIVE", "plan_name": "GROUP HEALTH COOPERATIVE", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "HEALTHGRAM", "plan_name": "HEALTHGRAM", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "Humana", "plan_name": "Humana", "standard_charge_dollar": 400.0, "methodology": "fee schedule" }, { "payer_name": "Inetico", "plan_name": "Inetico", "standard_charge_dollar": 507.0, "methodology": "fee schedule" }, { "payer_name": "Insurance TPA -Life Shield", "plan_name": "Insurance TPA -Life Shield", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "Maestro Health", "plan_name": "Maestro Health", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "MAGELLAN HEALTH SERVICES", "plan_name": "MAGELLAN HEALTH SERVICES", "standard_charge_dollar": 524.0, "methodology": "fee schedule" }, { "payer_name": "MAILHANDLERS BENEFIT PLAN", "plan_name": "MAILHANDLERS BENEFIT PLAN", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "MedCost Benefit Services", "plan_name": "MedCost Benefit Services", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "Medica", "plan_name": "Medica", "standard_charge_dollar": 325.0, "methodology": "fee schedule" }, { "payer_name": "MEDICAL MUTUAL OF OHIO", "plan_name": "MEDICAL MUTUAL OF OHIO", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "Meritain Health", "plan_name": "Meritain Health", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "MH NET", "plan_name": "MH NET", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "North America Administrators, L.P.", "plan_name": "North America Administrators, L.P.", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "OPTUM", "plan_name": "OPTUM", "standard_charge_dollar": 434.0, "methodology": "fee schedule" }, { "payer_name": "Optum VACCN", "plan_name": "Optum VACCN", "standard_charge_dollar": 1083.54, "methodology": "fee schedule" }, { "payer_name": "PCIP", "plan_name": "PCIP", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "Philadelphia American Life Insurance", "plan_name": "Philadelphia American Life Insurance", "standard_charge_dollar": 310.0, "methodology": "fee schedule" }, { "payer_name": "Piedmont Healthcare", "plan_name": "Piedmont Healthcare", "standard_charge_dollar": 310.0, "methodology": "fee schedule" }, { "payer_name": "PRIMARY PHYSICIAN CARE", "plan_name": "PRIMARY PHYSICIAN CARE", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "Prium Worker's Comp. Claims", "plan_name": "Prium Worker's Comp. Claims", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "S And S Healthcare Strategies TPA", "plan_name": "S And S Healthcare Strategies TPA", "standard_charge_dollar": 530.0, "methodology": "fee schedule" }, { "payer_name": "SECURE HEALTH", "plan_name": "SECURE HEALTH", "standard_charge_dollar": 548.34, "methodology": "fee schedule" }, { "payer_name": "Select Administrative Services Medwatch", "plan_name": "Select Administrative Services Medwatch", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "STATE FARM HEALTH", "plan_name": "STATE FARM HEALTH", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "SUPER MED", "plan_name": "SUPER MED", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "Surest", "plan_name": "Surest", "standard_charge_dollar": 325.0, "methodology": "fee schedule" }, { "payer_name": "TAYLOR BENEFIT RESOURCE", "plan_name": "TAYLOR BENEFIT RESOURCE", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "The Care Network Repricing", "plan_name": "The Care Network Repricing", "standard_charge_dollar": 555.0, "methodology": "fee schedule" }, { "payer_name": "TLC Benefit Solutions, Inc", "plan_name": "TLC Benefit Solutions, Inc", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "UBH", "plan_name": "UBH", "standard_charge_dollar": 434.0, "methodology": "fee schedule" }, { "payer_name": "UBH/MHBP", "plan_name": "UBH/MHBP", "standard_charge_dollar": 434.0, "methodology": "fee schedule" }, { "payer_name": "UHC", "plan_name": "UHC", "standard_charge_dollar": 434.0, "methodology": "fee schedule" }, { "payer_name": "UHC Shared Services", "plan_name": "UHC Shared Services", "standard_charge_dollar": 434.0, "methodology": "fee schedule" }, { "payer_name": "UMR", "plan_name": "UMR", "standard_charge_dollar": 434.0, "methodology": "fee schedule" }, { "payer_name": "UNITED CLINICAL SERVICES", "plan_name": "UNITED CLINICAL SERVICES", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare Student Resources", "plan_name": "United Healthcare Student Resources", "standard_charge_dollar": 325.0, "methodology": "fee schedule" }, { "payer_name": "Valenz Access", "plan_name": "Valenz Access", "standard_charge_dollar": 607.0, "methodology": "fee schedule" } ], "gross_charge": 2500.0, "discounted_cash": 550.0, "minimum": 125.0, "maximum": 1360.0 } ] }, { "description": "PHP - TELEHEALTH", "code_information": [ { "code": "H0035", "type": "HCPCS" }, { "code": "343", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Ambetter-Sunshine State", "plan_name": "Ambetter-Sunshine State", "standard_charge_dollar": 411.0, "methodology": "fee schedule" }, { "payer_name": "CareSource", "plan_name": "CareSource", "standard_charge_dollar": 380.0, "methodology": "fee schedule" }, { "payer_name": "Core Benefits Inc", "plan_name": "Core Benefits Inc", "standard_charge_dollar": 1360.0, "methodology": "fee schedule" }, { "payer_name": "Curative Health", "plan_name": "Curative Health", "standard_charge_dollar": 465.0, "methodology": "fee schedule" }, { "payer_name": "Geisinger Health Plan", "plan_name": "Geisinger Health Plan", "standard_charge_dollar": 1360.0, "methodology": "fee schedule" } ], "gross_charge": 2500.0, "discounted_cash": 550.0, "minimum": 380.0, "maximum": 1360.0 } ] }, { "description": "PHP w/BOARDING", "code_information": [ { "code": "H0035", "type": "HCPCS" }, { "code": "342", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna", "standard_charge_dollar": 643.0, "methodology": "fee schedule" }, { "payer_name": "All Savers Insurance - UHC", "plan_name": "All Savers Insurance - UHC", "standard_charge_dollar": 310.0, "methodology": "fee schedule" }, { "payer_name": "Alliant Health Plans", "plan_name": "Alliant Health Plans", "standard_charge_dollar": 400.29, "methodology": "fee schedule" }, { "payer_name": "ALLIED BENEFITS SYSTEM, INC", "plan_name": "ALLIED BENEFITS SYSTEM, INC", "standard_charge_dollar": 573.0, "methodology": "fee schedule" }, { "payer_name": "Ambetter-Sunshine State", "plan_name": "Ambetter-Sunshine State", "standard_charge_dollar": 411.0, "methodology": "fee schedule" }, { "payer_name": "AMERI HEALTH NEW JERSEY", "plan_name": "AMERI HEALTH NEW JERSEY", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "AMERICAN BEHAVIORAL BENEFIT MG", "plan_name": "AMERICAN BEHAVIORAL BENEFIT MG", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "Anthem BCBS HMO", "plan_name": "Anthem BCBS HMO", "standard_charge_dollar": 500.0, "methodology": "fee schedule" }, { "payer_name": "Anthem BCBS Pathways", "plan_name": "Anthem BCBS Pathways", "standard_charge_dollar": 477.0, "methodology": "fee schedule" }, { "payer_name": "Anthem BCBS PPO", "plan_name": "Anthem BCBS PPO", "standard_charge_dollar": 515.0, "methodology": "fee schedule" }, { "payer_name": "Anthem Blue Value", "plan_name": "Anthem Blue Value", "standard_charge_dollar": 440.0, "methodology": "fee schedule" }, { "payer_name": "Assured Benefit Administrators", "plan_name": "Assured Benefit Administrators", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Federal", "plan_name": "BCBS Federal", "standard_charge_dollar": 515.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Out Of Area", "plan_name": "BCBS Out Of Area", "standard_charge_dollar": 441.33, "methodology": "fee schedule" }, { "payer_name": "BEACON HEALTH OPTIONS", "plan_name": "BEACON HEALTH OPTIONS", "standard_charge_dollar": 554.0, "methodology": "fee schedule" }, { "payer_name": "Benefit Plan Administrators", "plan_name": "Benefit Plan Administrators", "standard_charge_dollar": 400.0, "methodology": "fee schedule" }, { "payer_name": "Benefits Support IN", "plan_name": "Benefits Support IN", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "Bind Benefits", "plan_name": "Bind Benefits", "standard_charge_dollar": 294.0, "methodology": "fee schedule" }, { "payer_name": "Bright Health Commercial", "plan_name": "Bright Health Commercial", "standard_charge_dollar": 550.0, "methodology": "fee schedule" }, { "payer_name": "CAMERON & ASSOCIATES", "plan_name": "CAMERON & ASSOCIATES", "standard_charge_dollar": 125.0, "methodology": "fee schedule" }, { "payer_name": "Carelon Behavioral Health", "plan_name": "Carelon Behavioral Health", "standard_charge_dollar": 400.0, "methodology": "fee schedule" }, { "payer_name": "CareSource", "plan_name": "CareSource", "standard_charge_dollar": 380.0, "methodology": "fee schedule" }, { "payer_name": "Cigna", "plan_name": "Cigna", "standard_charge_dollar": 487.0, "methodology": "fee schedule" }, { "payer_name": "COMPSYCH", "plan_name": "COMPSYCH", "standard_charge_dollar": 468.0, "methodology": "fee schedule" }, { "payer_name": "CONSUMER LIFE INSURANCE CO", "plan_name": "CONSUMER LIFE INSURANCE CO", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "CORE ADMINSTRATIVE SERVICES", "plan_name": "CORE ADMINSTRATIVE SERVICES", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "Core Benefits Inc", "plan_name": "Core Benefits Inc", "standard_charge_dollar": 1360.0, "methodology": "fee schedule" }, { "payer_name": "CORE SOURCE", "plan_name": "CORE SOURCE", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "Coventry Health Care Of GA", "plan_name": "Coventry Health Care Of GA", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "Curative Health", "plan_name": "Curative Health", "standard_charge_dollar": 465.0, "methodology": "fee schedule" }, { "payer_name": "DEVON HEALTH REPRICING", "plan_name": "DEVON HEALTH REPRICING", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "EBMS Employee Benefit Management Service", "plan_name": "EBMS Employee Benefit Management Service", "standard_charge_dollar": 600.0, "methodology": "fee schedule" }, { "payer_name": "First Health Network", "plan_name": "First Health Network", "standard_charge_dollar": 607.0, "methodology": "fee schedule" }, { "payer_name": "GEHA (Aetna Signature Admin)", "plan_name": "GEHA (Aetna Signature Admin)", "standard_charge_dollar": 643.0, "methodology": "fee schedule" }, { "payer_name": "Geisinger Health Plan", "plan_name": "Geisinger Health Plan", "standard_charge_dollar": 1360.0, "methodology": "fee schedule" }, { "payer_name": "Global Care", "plan_name": "Global Care", "standard_charge_dollar": 507.0, "methodology": "fee schedule" }, { "payer_name": "Golden Rule", "plan_name": "Golden Rule", "standard_charge_dollar": 310.0, "methodology": "fee schedule" }, { "payer_name": "GROUP HEALTH COOPERATIVE", "plan_name": "GROUP HEALTH COOPERATIVE", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "HEALTHGRAM", "plan_name": "HEALTHGRAM", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "Healthscope/Aetna", "plan_name": "Healthscope/Aetna", "standard_charge_dollar": 643.0, "methodology": "fee schedule" }, { "payer_name": "Humana", "plan_name": "Humana", "standard_charge_dollar": 400.0, "methodology": "fee schedule" }, { "payer_name": "Industry Buying Group", "plan_name": "Industry Buying Group", "standard_charge_dollar": 484.0, "methodology": "fee schedule" }, { "payer_name": "Inetico", "plan_name": "Inetico", "standard_charge_dollar": 507.0, "methodology": "fee schedule" }, { "payer_name": "Insurance TPA -Life Shield", "plan_name": "Insurance TPA -Life Shield", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "Maestro Health", "plan_name": "Maestro Health", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "MAGELLAN HEALTH SERVICES", "plan_name": "MAGELLAN HEALTH SERVICES", "standard_charge_dollar": 524.0, "methodology": "fee schedule" }, { "payer_name": "MAILHANDLERS BENEFIT PLAN", "plan_name": "MAILHANDLERS BENEFIT PLAN", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "MedCost Benefit Services", "plan_name": "MedCost Benefit Services", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "Medica", "plan_name": "Medica", "standard_charge_dollar": 325.0, "methodology": "fee schedule" }, { "payer_name": "MEDICAL MUTUAL OF OHIO", "plan_name": "MEDICAL MUTUAL OF OHIO", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "Meritain Health", "plan_name": "Meritain Health", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "MH NET", "plan_name": "MH NET", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "North America Administrators, L.P.", "plan_name": "North America Administrators, L.P.", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "OPTUM", "plan_name": "OPTUM", "standard_charge_dollar": 434.0, "methodology": "fee schedule" }, { "payer_name": "Oxford Health Plans", "plan_name": "Oxford Health Plans", "standard_charge_dollar": 424.0, "methodology": "fee schedule" }, { "payer_name": "PCIP", "plan_name": "PCIP", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "Philadelphia American Life Insurance", "plan_name": "Philadelphia American Life Insurance", "standard_charge_dollar": 310.0, "methodology": "fee schedule" }, { "payer_name": "Piedmont Healthcare", "plan_name": "Piedmont Healthcare", "standard_charge_dollar": 412.0, "methodology": "fee schedule" }, { "payer_name": "PRIMARY PHYSICIAN CARE", "plan_name": "PRIMARY PHYSICIAN CARE", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "Prium Worker's Comp. Claims", "plan_name": "Prium Worker's Comp. Claims", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "Provider Network Of America", "plan_name": "Provider Network Of America", "standard_charge_dollar": 560.0, "methodology": "fee schedule" }, { "payer_name": "S And S Healthcare Strategies TPA", "plan_name": "S And S Healthcare Strategies TPA", "standard_charge_dollar": 530.0, "methodology": "fee schedule" }, { "payer_name": "SECURE HEALTH", "plan_name": "SECURE HEALTH", "standard_charge_dollar": 548.34, "methodology": "fee schedule" }, { "payer_name": "Select Administrative Services Medwatch", "plan_name": "Select Administrative Services Medwatch", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "STATE FARM HEALTH", "plan_name": "STATE FARM HEALTH", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "SUPER MED", "plan_name": "SUPER MED", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "Surest", "plan_name": "Surest", "standard_charge_dollar": 325.0, "methodology": "fee schedule" }, { "payer_name": "TAYLOR BENEFIT RESOURCE", "plan_name": "TAYLOR BENEFIT RESOURCE", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "The Care Network Repricing", "plan_name": "The Care Network Repricing", "standard_charge_dollar": 555.0, "methodology": "fee schedule" }, { "payer_name": "TLC Benefit Solutions, Inc", "plan_name": "TLC Benefit Solutions, Inc", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "Tricare East", "plan_name": "Tricare East", "standard_charge_dollar": 395.24, "methodology": "fee schedule" }, { "payer_name": "Trustmark Health Benefits", "plan_name": "Trustmark Health Benefits", "standard_charge_dollar": 643.0, "methodology": "fee schedule" }, { "payer_name": "UBH", "plan_name": "UBH", "standard_charge_dollar": 434.0, "methodology": "fee schedule" }, { "payer_name": "UBH/MHBP", "plan_name": "UBH/MHBP", "standard_charge_dollar": 434.0, "methodology": "fee schedule" }, { "payer_name": "UHC", "plan_name": "UHC", "standard_charge_dollar": 434.0, "methodology": "fee schedule" }, { "payer_name": "UHC Shared Services", "plan_name": "UHC Shared Services", "standard_charge_dollar": 434.0, "methodology": "fee schedule" }, { "payer_name": "UMR", "plan_name": "UMR", "standard_charge_dollar": 434.0, "methodology": "fee schedule" }, { "payer_name": "UNITED CLINICAL SERVICES", "plan_name": "UNITED CLINICAL SERVICES", "standard_charge_dollar": 625.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare Student Resources", "plan_name": "United Healthcare Student Resources", "standard_charge_dollar": 325.0, "methodology": "fee schedule" }, { "payer_name": "Valenz Access", "plan_name": "Valenz Access", "standard_charge_dollar": 607.0, "methodology": "fee schedule" } ], "gross_charge": 2500.0, "discounted_cash": 550.0, "minimum": 125.0, "maximum": 1360.0 } ] }, { "description": "FAMILY THERAPY", "code_information": [ { "code": "90847", "type": "CPT" }, { "code": "90847", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna", "standard_charge_dollar": 68.25, "methodology": "fee schedule" }, { "payer_name": "AMERI HEALTH NEW JERSEY", "plan_name": "AMERI HEALTH NEW JERSEY", "standard_charge_dollar": 65.0, "methodology": "fee schedule" }, { "payer_name": "AMERICAN BEHAVIORAL BENEFIT MG", "plan_name": "AMERICAN BEHAVIORAL BENEFIT MG", "standard_charge_dollar": 65.0, "methodology": "fee schedule" }, { "payer_name": "Anthem BCBS HMO", "plan_name": "Anthem BCBS HMO", "standard_charge_dollar": 189.88, "methodology": "fee schedule" }, { "payer_name": "Anthem BCBS Pathways", "plan_name": "Anthem BCBS Pathways", "standard_charge_dollar": 189.88, "methodology": "fee schedule" }, { "payer_name": "Anthem BCBS PPO", "plan_name": "Anthem BCBS PPO", "standard_charge_dollar": 65.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Federal", "plan_name": "BCBS Federal", "standard_charge_dollar": 65.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Out Of Area", "plan_name": "BCBS Out Of Area", "standard_charge_dollar": 65.0, "methodology": "fee schedule" }, { "payer_name": "BEACON HEALTH OPTIONS", "plan_name": "BEACON HEALTH OPTIONS", "standard_charge_dollar": 65.0, "methodology": "fee schedule" }, { "payer_name": "CAMERON & ASSOCIATES", "plan_name": "CAMERON & ASSOCIATES", "standard_charge_dollar": 65.0, "methodology": "fee schedule" }, { "payer_name": "Cigna", "plan_name": "Cigna", "standard_charge_dollar": 189.88, "methodology": "fee schedule" }, { "payer_name": "CONSUMER LIFE INSURANCE CO", "plan_name": "CONSUMER LIFE INSURANCE CO", "standard_charge_dollar": 65.0, "methodology": "fee schedule" }, { "payer_name": "CORE ADMINSTRATIVE SERVICES", "plan_name": "CORE ADMINSTRATIVE SERVICES", "standard_charge_dollar": 65.0, "methodology": "fee schedule" }, { "payer_name": 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Claims", "plan_name": "Prium Worker's Comp. 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"standard_charge_dollar": 65.0, "methodology": "fee schedule" }, { "payer_name": "TLC Benefit Solutions, Inc", "plan_name": "TLC Benefit Solutions, Inc", "standard_charge_dollar": 65.0, "methodology": "fee schedule" }, { "payer_name": "Trustmark Health Benefits", "plan_name": "Trustmark Health Benefits", "standard_charge_dollar": 65.0, "methodology": "fee schedule" }, { "payer_name": "UBH", "plan_name": "UBH", "standard_charge_dollar": 65.0, "methodology": "fee schedule" }, { "payer_name": "UBH/MHBP", "plan_name": "UBH/MHBP", "standard_charge_dollar": 65.0, "methodology": "fee schedule" }, { "payer_name": "UHC", "plan_name": "UHC", "standard_charge_dollar": 65.0, "methodology": "fee schedule" }, { "payer_name": "UHC Shared Services", "plan_name": "UHC Shared Services", "standard_charge_dollar": 65.0, "methodology": "fee schedule" }, { "payer_name": "UMR", "plan_name": "UMR", "standard_charge_dollar": 65.0, "methodology": "fee schedule" }, { "payer_name": "UNITED CLINICAL SERVICES", "plan_name": "UNITED CLINICAL SERVICES", "standard_charge_dollar": 65.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare Student Resources", "plan_name": "United Healthcare Student Resources", "standard_charge_dollar": 65.0, "methodology": "fee schedule" }, { "payer_name": "Valenz Access", "plan_name": "Valenz Access", "standard_charge_dollar": 65.0, "methodology": "fee schedule" }, { "payer_name": "Value Options", "plan_name": "Value Options", "standard_charge_dollar": 65.0, "methodology": "fee schedule" } ], "gross_charge": 310.0, "discounted_cash": 50.0, "minimum": 65.0, "maximum": 123.97 } ] }, { "description": "IND THERAPY - 45 MIN TELEHEALTH", "code_information": [ { "code": "90834", "type": "CPT" }, { "code": "908342", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "AMERI HEALTH NEW JERSEY", "plan_name": "AMERI HEALTH NEW JERSEY", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "Anthem BCBS PPO", "plan_name": "Anthem BCBS PPO", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Federal", "plan_name": "BCBS Federal", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "BCBS Out Of Area", "plan_name": "BCBS Out Of Area", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "BEACON HEALTH OPTIONS", "plan_name": "BEACON HEALTH OPTIONS", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "CAMERON & ASSOCIATES", "plan_name": "CAMERON & ASSOCIATES", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "CONSUMER LIFE INSURANCE CO", "plan_name": "CONSUMER LIFE INSURANCE CO", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "CORE ADMINSTRATIVE SERVICES", "plan_name": "CORE ADMINSTRATIVE SERVICES", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "CORE SOURCE", "plan_name": "CORE SOURCE", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "Coventry Health Care Of GA", "plan_name": "Coventry Health Care Of GA", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "DEVON HEALTH REPRICING", "plan_name": "DEVON HEALTH REPRICING", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "First Health Network", "plan_name": "First Health Network", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "GEHA (Aetna Signature Admin)", "plan_name": "GEHA (Aetna Signature Admin)", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "Global Care", "plan_name": "Global Care", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "Golden Rule", "plan_name": "Golden Rule", "standard_charge_dollar": 65.0, "methodology": "fee schedule" }, { "payer_name": "GROUP HEALTH COOPERATIVE", "plan_name": "GROUP HEALTH COOPERATIVE", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "HEALTHGRAM", "plan_name": "HEALTHGRAM", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "Healthscope/Aetna", "plan_name": "Healthscope/Aetna", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "Humana", "plan_name": "Humana", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "Inetico", "plan_name": "Inetico", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "Insurance TPA -Life Shield", "plan_name": "Insurance TPA -Life Shield", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "Maestro Health", "plan_name": "Maestro Health", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "MAILHANDLERS BENEFIT PLAN", "plan_name": "MAILHANDLERS BENEFIT PLAN", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "MedCost Benefit Services", "plan_name": "MedCost Benefit Services", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "MEDICAL MUTUAL OF OHIO", "plan_name": "MEDICAL MUTUAL OF OHIO", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "Meritain Health", "plan_name": "Meritain Health", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "MH NET", "plan_name": "MH NET", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "North America Administrators, L.P.", "plan_name": "North America Administrators, L.P.", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "OPTUM", "plan_name": "OPTUM", "standard_charge_dollar": 65.0, "methodology": "fee schedule" }, { "payer_name": "Oxford Health Plans", "plan_name": "Oxford Health Plans", "standard_charge_dollar": 175.0, "methodology": "fee schedule" }, { "payer_name": "PCIP", "plan_name": "PCIP", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "Philadelphia American Life Insurance", "plan_name": "Philadelphia American Life Insurance", "standard_charge_dollar": 175.0, "methodology": "fee schedule" }, { "payer_name": "Piedmont Healthcare", "plan_name": "Piedmont Healthcare", "standard_charge_dollar": 175.0, "methodology": "fee schedule" }, { "payer_name": "PRIMARY PHYSICIAN CARE", "plan_name": "PRIMARY PHYSICIAN CARE", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "Prium Worker's Comp. Claims", "plan_name": "Prium Worker's Comp. Claims", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "SECURE HEALTH", "plan_name": "SECURE HEALTH", "standard_charge_dollar": 98.54, "methodology": "fee schedule" }, { "payer_name": "Select Administrative Services Medwatch", "plan_name": "Select Administrative Services Medwatch", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "STATE FARM HEALTH", "plan_name": "STATE FARM HEALTH", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "SUPER MED", "plan_name": "SUPER MED", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "Surest", "plan_name": "Surest", "standard_charge_dollar": 65.0, "methodology": "fee schedule" }, { "payer_name": "TAYLOR BENEFIT RESOURCE", "plan_name": "TAYLOR BENEFIT RESOURCE", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "The Care Network Repricing", "plan_name": "The Care Network Repricing", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "TLC Benefit Solutions, Inc", "plan_name": "TLC Benefit Solutions, Inc", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "Trustmark Health Benefits", "plan_name": "Trustmark Health Benefits", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "UBH", "plan_name": "UBH", "standard_charge_dollar": 65.0, "methodology": "fee schedule" }, { "payer_name": "UBH/MHBP", "plan_name": "UBH/MHBP", "standard_charge_dollar": 65.0, "methodology": "fee schedule" }, { "payer_name": "UHC", "plan_name": "UHC", "standard_charge_dollar": 65.0, "methodology": "fee schedule" }, { "payer_name": "UHC Shared Services", "plan_name": "UHC Shared Services", "standard_charge_dollar": 65.0, "methodology": "fee schedule" }, { "payer_name": "UMR", "plan_name": "UMR", "standard_charge_dollar": 65.0, "methodology": "fee schedule" }, { "payer_name": "UNITED CLINICAL SERVICES", "plan_name": "UNITED CLINICAL SERVICES", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "United Healthcare Student Resources", "plan_name": "United Healthcare Student Resources", "standard_charge_dollar": 65.0, "methodology": "fee schedule" }, { "payer_name": "Valenz Access", "plan_name": "Valenz Access", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "Value Options", "plan_name": "Value Options", "standard_charge_dollar": 85.0, "methodology": "fee schedule" } ], "gross_charge": 310.0, "discounted_cash": 65.0, "minimum": 65.0, "maximum": 175.0 } ] }, { "description": "INDIVIDUAL COUNSELING - 60 MIN", "code_information": [ { "code": "90837", "type": "CPT" }, { "code": "90837", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Oxford Health Plans", "plan_name": "Oxford Health Plans", "standard_charge_dollar": 140.0, "methodology": "fee schedule" }, { "payer_name": "Philadelphia American Life Insurance", "plan_name": "Philadelphia American Life Insurance", "standard_charge_dollar": 140.0, "methodology": "fee schedule" }, { "payer_name": "Piedmont Healthcare", "plan_name": "Piedmont Healthcare", "standard_charge_dollar": 140.0, "methodology": "fee schedule" } ], "gross_charge": 250.0, "discounted_cash": 65.0, "minimum": 140.0, "maximum": 140.0 } ] }, { "description": "INDIVIDUAL THERAPY", "code_information": [ { "code": "90834", "type": "CPT" }, { "code": "908340", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Industry Buying Group", "plan_name": "Industry Buying Group", "standard_charge_dollar": 103.0, "methodology": "fee schedule" } ], "gross_charge": 310.0, "discounted_cash": 65.0, "minimum": 103.0, "maximum": 103.0 } ] }, { "description": "OUTPATIENT - IND THERAPY", "code_information": [ { "code": "90834", "type": "CPT" }, { "code": "90834", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna", "standard_charge_dollar": 68.25, "methodology": "fee schedule" }, { "payer_name": "All Savers Insurance - UHC", "plan_name": "All Savers Insurance - UHC", "standard_charge_dollar": 68.25, "methodology": "fee schedule" }, { "payer_name": "Alliant Health Plans", "plan_name": "Alliant Health Plans", "standard_charge_dollar": 123.97, "methodology": "fee schedule" }, { "payer_name": "AMERI HEALTH NEW JERSEY", "plan_name": "AMERI HEALTH NEW JERSEY", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "AMERICAN BEHAVIORAL BENEFIT MG", "plan_name": "AMERICAN BEHAVIORAL BENEFIT MG", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "Anthem BCBS HMO", "plan_name": "Anthem BCBS HMO", "standard_charge_dollar": 189.88, "methodology": "fee schedule" }, { "payer_name": "Anthem BCBS Pathways", "plan_name": "Anthem BCBS Pathways", "standard_charge_dollar": 189.88, "methodology": "fee schedule" }, { "payer_name": "Anthem BCBS PPO", "plan_name": "Anthem BCBS PPO", "standard_charge_dollar": 189.88, "methodology": "fee schedule" }, { "payer_name": "Anthem Blue Value", "plan_name": "Anthem Blue Value", "standard_charge_dollar": 189.88, "methodology": "fee schedule" }, { "payer_name": "BCBS Federal", "plan_name": "BCBS Federal", "standard_charge_dollar": 175.0, "methodology": "fee schedule" }, { "payer_name": "BEACON HEALTH OPTIONS", "plan_name": "BEACON HEALTH OPTIONS", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "Benefit Plan Administrators", "plan_name": "Benefit Plan Administrators", "standard_charge_dollar": 100.0, "methodology": "fee schedule" }, { "payer_name": "Benefits Support IN", "plan_name": "Benefits Support IN", "standard_charge_dollar": 150.0, "methodology": "fee schedule" }, { "payer_name": "CAMERON & ASSOCIATES", "plan_name": "CAMERON & ASSOCIATES", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "Carelon Behavioral Health", "plan_name": "Carelon Behavioral Health", "standard_charge_dollar": 100.0, "methodology": "fee schedule" }, { "payer_name": "Cigna", "plan_name": "Cigna", "standard_charge_dollar": 217.0, "methodology": "fee schedule" }, { "payer_name": "CONSUMER LIFE INSURANCE CO", "plan_name": "CONSUMER LIFE INSURANCE CO", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "CORE ADMINSTRATIVE SERVICES", "plan_name": "CORE ADMINSTRATIVE SERVICES", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "CORE SOURCE", "plan_name": "CORE SOURCE", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "Coventry Health Care Of GA", "plan_name": "Coventry Health Care Of GA", "standard_charge_dollar": 85.0, "methodology": "fee schedule" }, { "payer_name": "DEVON HEALTH REPRICING", "plan_name": "DEVON HEALTH REPRICING", 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