{ "hospital_name": "SBH-Wilmington, LLC", "last_updated_on": "2026-04-29", "version": "3.0.0", "location_name": [ "Carolina Dunes Behavioral Health" ], "hospital_address": [ "2050 Mercantile Dr, Leland, NC 28451" ], "license_information": { "state": "NC", "license_number": "135" }, "type_2_npi": [ "1639357429" ], "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.\nFor 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": "Steve McCabe" }, "standard_charge_information": [ { "description": "DC >30 Minutes", "code_information": [ { "code": "99239", "type": "CPT" }, { "code": "99239", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Vaya Health", "plan_name": "Vaya Health", "standard_charge_dollar": 88.81, "methodology": "fee schedule", "additional_payer_notes": "" } ], "minimum": 88.81, "maximum": 88.81 } ] }, { "description": "Hospital Discharge 30 min.", "code_information": [ { "code": "99238", "type": "CPT" }, { "code": "89238", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 61.11, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Aetna Medicare Advantage Plan", "plan_name": "Aetna Medicare Advantage Plan", "standard_charge_dollar": 61.11, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Alliance Behavioral Health", "plan_name": "Alliance Behavioral Health", "standard_charge_dollar": 61.11, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "AmeriHealth Caritas Of NC Medicaid", "plan_name": "AmeriHealth Caritas Of NC Medicaid", "standard_charge_dollar": 59.28, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "BCBS STATE HEALTH PLAN", "plan_name": "BCBS STATE HEALTH PLAN", "standard_charge_dollar": 61.11, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "BCBSNC", "plan_name": "BCBSNC", "standard_charge_dollar": 61.11, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Blue Medicare Advantage Plan", "plan_name": "Blue Medicare Advantage Plan", "standard_charge_dollar": 61.11, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Cardinal Innovations", "plan_name": "Cardinal Innovations", "standard_charge_dollar": 61.11, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Carelon - Beacon Health Options", "plan_name": "Carelon - Beacon Health Options", "standard_charge_dollar": 61.11, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Carolina Complete Health Medicaid", "plan_name": "Carolina Complete Health Medicaid", "standard_charge_dollar": 59.28, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Centerpoint Human Services", "plan_name": "Centerpoint Human Services", "standard_charge_dollar": 61.11, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Cigna Behavioral Health", "plan_name": "Cigna Behavioral Health", "standard_charge_dollar": 61.11, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Cigna Great West", "plan_name": "Cigna Great West", "standard_charge_dollar": 61.11, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "CIGNA HEALTHCARE", "plan_name": "CIGNA HEALTHCARE", "standard_charge_dollar": 61.11, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "CIHA Cherokee Indian Hospital", "plan_name": "CIHA Cherokee Indian Hospital", "standard_charge_dollar": 61.11, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "CoastalCare", "plan_name": "CoastalCare", "standard_charge_dollar": 61.11, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Coventry Health", "plan_name": "Coventry Health", "standard_charge_dollar": 61.11, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Devoted Health, Inc.", "plan_name": "Devoted Health, Inc.", "standard_charge_dollar": 61.11, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "East Carolina Behavioral Health", "plan_name": "East Carolina Behavioral Health", "standard_charge_dollar": 67.22, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Eastpointe Human Services", "plan_name": "Eastpointe Human Services", "standard_charge_dollar": 62.94, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "GEHA Government Employee Health", "plan_name": "GEHA Government Employee Health", "standard_charge_dollar": 61.11, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Guardian", "plan_name": "Guardian", "standard_charge_dollar": 61.11, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Health Alliance", "plan_name": "Health Alliance", "standard_charge_dollar": 61.11, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Health Choice", "plan_name": "Health Choice", "standard_charge_dollar": 59.28, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "HealthSmart", "plan_name": "HealthSmart", "standard_charge_dollar": 61.11, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Healthy Blue BCBS Medicaid", "plan_name": "Healthy Blue BCBS Medicaid", "standard_charge_dollar": 64.61, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Humana Medicare", "plan_name": "Humana Medicare", "standard_charge_dollar": 61.11, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "MeckLink Behavioral Healthcare", "plan_name": "MeckLink Behavioral Healthcare", "standard_charge_dollar": 61.11, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "MedCost", "plan_name": "MedCost", "standard_charge_dollar": 61.11, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Medical Mutual Of Ohio", "plan_name": "Medical Mutual Of Ohio", "standard_charge_dollar": 61.11, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Optima Health VA Medicaid", "plan_name": "Optima Health VA Medicaid", "standard_charge_dollar": 120.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Optum Health", "plan_name": "Optum Health", "standard_charge_dollar": 61.11, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Partners Behavioral Health Management", "plan_name": "Partners Behavioral Health Management", "standard_charge_dollar": 59.28, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Physicians Mutual Insurance", "plan_name": "Physicians Mutual Insurance", "standard_charge_dollar": 61.11, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Sandhills Center", "plan_name": "Sandhills Center", "standard_charge_dollar": 76.11, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Trillium Health Resources", "plan_name": "Trillium Health Resources", "standard_charge_dollar": 67.22, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "UHC Community Plan Medicaid", "plan_name": "UHC Community Plan Medicaid", "standard_charge_dollar": 59.28, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "UHC Medicare Advantage Plan", "plan_name": "UHC Medicare Advantage Plan", "standard_charge_dollar": 61.11, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "UMR", "plan_name": "UMR", "standard_charge_dollar": 61.11, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health", "standard_charge_dollar": 61.11, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare", "standard_charge_dollar": 120.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Value Options", "plan_name": "Value Options", "standard_charge_dollar": 61.11, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Vaya Health", "plan_name": "Vaya Health", "standard_charge_dollar": 61.11, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Wellcare Of NC Medicaid", "plan_name": "Wellcare Of NC Medicaid", "standard_charge_dollar": 59.28, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Western Highlands", "plan_name": "Western Highlands", "standard_charge_dollar": 61.11, "methodology": "fee schedule", "additional_payer_notes": "" } ], "minimum": 59.28, "maximum": 120.0 } ] }, { "description": "Initial Hosp Scv Low 30 min", "code_information": [ { "code": "99221", "type": "CPT" }, { "code": "89221", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 83.05, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Aetna Medicare Advantage Plan", "plan_name": "Aetna Medicare Advantage Plan", "standard_charge_dollar": 83.05, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "All Savers", "plan_name": "All Savers", "standard_charge_dollar": 83.05, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Alliance Behavioral Health", "plan_name": "Alliance Behavioral Health", "standard_charge_dollar": 83.05, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "AmeriHealth Caritas Of NC Medicaid", "plan_name": "AmeriHealth Caritas Of NC Medicaid", "standard_charge_dollar": 83.05, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "BCBS STATE HEALTH PLAN", "plan_name": "BCBS STATE HEALTH PLAN", "standard_charge_dollar": 83.05, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "BCBSNC", "plan_name": "BCBSNC", "standard_charge_dollar": 83.05, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Blue Medicare Advantage Plan", "plan_name": "Blue Medicare Advantage Plan", "standard_charge_dollar": 83.05, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Cardinal Innovations", "plan_name": "Cardinal Innovations", "standard_charge_dollar": 83.05, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Carelon - Beacon Health Options", "plan_name": "Carelon - Beacon Health Options", "standard_charge_dollar": 83.05, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Carolina Complete Health Medicaid", "plan_name": "Carolina Complete Health Medicaid", "standard_charge_dollar": 83.05, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Centerpoint Human Services", "plan_name": "Centerpoint Human Services", "standard_charge_dollar": 83.05, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Cigna Behavioral Health", "plan_name": "Cigna Behavioral Health", "standard_charge_dollar": 83.05, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "CIGNA HEALTHCARE", "plan_name": "CIGNA HEALTHCARE", "standard_charge_dollar": 83.05, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "CIHA Cherokee Indian Hospital", "plan_name": "CIHA Cherokee Indian Hospital", "standard_charge_dollar": 83.05, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Coventry Health", "plan_name": "Coventry Health", "standard_charge_dollar": 83.05, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Devoted Health, Inc.", "plan_name": "Devoted Health, Inc.", "standard_charge_dollar": 83.05, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "East Carolina Behavioral Health", "plan_name": "East Carolina Behavioral Health", "standard_charge_dollar": 93.84, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Eastpointe Human Services", "plan_name": "Eastpointe Human Services", "standard_charge_dollar": 83.05, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "GEHA Government Employee Health", "plan_name": "GEHA Government Employee Health", "standard_charge_dollar": 83.05, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Guardian", "plan_name": "Guardian", "standard_charge_dollar": 83.05, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Health Alliance", "plan_name": "Health Alliance", "standard_charge_dollar": 83.05, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Health Choice", "plan_name": "Health Choice", "standard_charge_dollar": 83.05, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "HealthSmart", "plan_name": "HealthSmart", "standard_charge_dollar": 83.05, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Healthy Blue BCBS Medicaid", "plan_name": "Healthy Blue BCBS Medicaid", "standard_charge_dollar": 83.05, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Humana Medicare", "plan_name": "Humana Medicare", "standard_charge_dollar": 83.05, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "MeckLink Behavioral Healthcare", "plan_name": "MeckLink Behavioral Healthcare", "standard_charge_dollar": 83.05, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "MedCost", "plan_name": "MedCost", "standard_charge_dollar": 83.05, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Medical Mutual Of Ohio", "plan_name": "Medical Mutual Of Ohio", "standard_charge_dollar": 83.05, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Optima Health VA Medicaid", "plan_name": "Optima Health VA Medicaid", "standard_charge_dollar": 120.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Optum Health", "plan_name": "Optum Health", "standard_charge_dollar": 83.05, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Partners Behavioral Health Management", "plan_name": "Partners Behavioral Health Management", "standard_charge_dollar": 83.05, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Physicians Mutual Insurance", "plan_name": "Physicians Mutual Insurance", "standard_charge_dollar": 83.05, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Sandhills Center", "plan_name": "Sandhills Center", "standard_charge_dollar": 103.43, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "UHC Community Plan Medicaid", "plan_name": "UHC Community Plan Medicaid", "standard_charge_dollar": 83.05, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "UHC Medicare Advantage Plan", "plan_name": "UHC Medicare Advantage Plan", "standard_charge_dollar": 83.05, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "UMR", "plan_name": "UMR", "standard_charge_dollar": 83.05, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare", "standard_charge_dollar": 120.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Value Options", "plan_name": "Value Options", "standard_charge_dollar": 83.05, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Wellcare Of NC Medicaid", "plan_name": "Wellcare Of NC Medicaid", "standard_charge_dollar": 83.05, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Western Highlands", "plan_name": "Western Highlands", "standard_charge_dollar": 83.05, "methodology": "fee schedule", "additional_payer_notes": "" } ], "minimum": 83.05, "maximum": 120.0 } ] }, { "description": "Initial Hosp Scv Mod 50 min", "code_information": [ { "code": "99222", "type": "CPT" }, { "code": "89222", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 113.34, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Aetna Medicare Advantage Plan", "plan_name": "Aetna Medicare Advantage Plan", "standard_charge_dollar": 113.34, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "All Savers", "plan_name": "All Savers", "standard_charge_dollar": 113.34, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Alliance Behavioral Health", "plan_name": "Alliance Behavioral Health", "standard_charge_dollar": 113.34, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "AmeriHealth Caritas Of NC Medicaid", "plan_name": "AmeriHealth Caritas Of NC Medicaid", "standard_charge_dollar": 113.34, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "BCBS STATE HEALTH PLAN", "plan_name": "BCBS STATE HEALTH PLAN", "standard_charge_dollar": 113.34, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "BCBSNC", "plan_name": "BCBSNC", "standard_charge_dollar": 113.34, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Blue Medicare Advantage Plan", "plan_name": "Blue Medicare Advantage Plan", "standard_charge_dollar": 113.34, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Cardinal Innovations", "plan_name": "Cardinal Innovations", "standard_charge_dollar": 113.34, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Carelon - Beacon Health Options", "plan_name": "Carelon - Beacon Health Options", "standard_charge_dollar": 113.34, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Carolina Complete Health Medicaid", "plan_name": "Carolina Complete Health Medicaid", "standard_charge_dollar": 113.34, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Centerpoint Human Services", "plan_name": "Centerpoint Human Services", "standard_charge_dollar": 113.34, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Cigna Behavioral Health", "plan_name": "Cigna Behavioral Health", "standard_charge_dollar": 113.34, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "CIGNA HEALTHCARE", "plan_name": "CIGNA HEALTHCARE", "standard_charge_dollar": 113.34, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "CIHA Cherokee Indian Hospital", "plan_name": "CIHA Cherokee Indian Hospital", "standard_charge_dollar": 113.34, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "CoastalCare", "plan_name": "CoastalCare", "standard_charge_dollar": 113.34, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Coventry Health", "plan_name": "Coventry Health", "standard_charge_dollar": 113.34, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Devoted Health, Inc.", "plan_name": "Devoted Health, Inc.", "standard_charge_dollar": 113.34, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "East Carolina Behavioral Health", "plan_name": "East Carolina Behavioral Health", "standard_charge_dollar": 124.67, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Eastpointe Human Services", "plan_name": "Eastpointe Human Services", "standard_charge_dollar": 116.74, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "GEHA Government Employee Health", "plan_name": "GEHA Government Employee Health", "standard_charge_dollar": 113.34, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Guardian", "plan_name": "Guardian", "standard_charge_dollar": 113.34, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Health Alliance", "plan_name": "Health Alliance", "standard_charge_dollar": 113.34, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Health Choice", "plan_name": "Health Choice", "standard_charge_dollar": 113.34, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "HealthSmart", "plan_name": "HealthSmart", "standard_charge_dollar": 113.34, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Healthy Blue BCBS Medicaid", "plan_name": "Healthy Blue BCBS Medicaid", "standard_charge_dollar": 113.34, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Humana Medicare", "plan_name": "Humana Medicare", "standard_charge_dollar": 113.34, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "MeckLink Behavioral Healthcare", "plan_name": "MeckLink Behavioral Healthcare", "standard_charge_dollar": 113.34, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "MedCost", "plan_name": "MedCost", "standard_charge_dollar": 113.34, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Medical Mutual Of Ohio", "plan_name": "Medical Mutual Of Ohio", "standard_charge_dollar": 113.34, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Optima Health VA Medicaid", "plan_name": "Optima Health VA Medicaid", "standard_charge_dollar": 120.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Optum Health", "plan_name": "Optum Health", "standard_charge_dollar": 113.34, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Partners Behavioral Health Management", "plan_name": "Partners Behavioral Health Management", "standard_charge_dollar": 113.34, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Physicians Mutual Insurance", "plan_name": "Physicians Mutual Insurance", "standard_charge_dollar": 113.34, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Sandhills Center", "plan_name": "Sandhills Center", "standard_charge_dollar": 141.15, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Trillium Health Resources", "plan_name": "Trillium Health Resources", "standard_charge_dollar": 133.34, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "UHC Community Plan Medicaid", "plan_name": "UHC Community Plan Medicaid", "standard_charge_dollar": 113.34, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "UHC Medicare Advantage Plan", "plan_name": "UHC Medicare Advantage Plan", "standard_charge_dollar": 113.34, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "UMR", "plan_name": "UMR", "standard_charge_dollar": 113.34, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health", "standard_charge_dollar": 113.34, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare", "standard_charge_dollar": 120.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Value Options", "plan_name": "Value Options", "standard_charge_dollar": 113.34, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Wellcare Of NC Medicaid", "plan_name": "Wellcare Of NC Medicaid", "standard_charge_dollar": 113.34, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Western Highlands", "plan_name": "Western Highlands", "standard_charge_dollar": 113.34, "methodology": "fee schedule", "additional_payer_notes": "" } ], "minimum": 113.34, "maximum": 141.15 } ] }, { "description": "PHP Daily Adult", "code_information": [ { "code": "H0035", "type": "HCPCS" }, { "code": "401", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Carolina Complete Health Medicaid", "plan_name": "Carolina Complete Health Medicaid", "standard_charge_dollar": 300.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Healthy Blue BCBS Medicaid", "plan_name": "Healthy Blue BCBS Medicaid", "standard_charge_dollar": 325.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Quik Trip HMO", "plan_name": "Quik Trip HMO", "standard_charge_dollar": 300.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "UHC Community Plan Medicaid", "plan_name": "UHC Community Plan Medicaid", "standard_charge_dollar": 300.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Wellcare Of NC Medicaid", "plan_name": "Wellcare Of NC Medicaid", "standard_charge_dollar": 275.0, "methodology": "fee schedule", "additional_payer_notes": "" } ], "minimum": 275.0, "maximum": 325.0 } ] }, { "description": "SUBSEQ HOSP (25 MIN)", "code_information": [ { "code": "99232", "type": "CPT" }, { "code": "99232", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Vaya Health", "plan_name": "Vaya Health", "standard_charge_dollar": 62.96, "methodology": "fee schedule", "additional_payer_notes": "" } ], "minimum": 62.96, "maximum": 62.96 } ] }, { "description": "SUBSEQ HOSP (35 MIN)", "code_information": [ { "code": "99233", "type": "CPT" }, { "code": "99233", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Vaya Health", "plan_name": "Vaya Health", "standard_charge_dollar": 90.16, "methodology": "fee schedule", "additional_payer_notes": "" } ], "minimum": 90.16, "maximum": 90.16 } ] }, { "description": "Subsequent Hospital 15 min", "code_information": [ { "code": "99231", "type": "CPT" }, { "code": "89231", "type": "LOCAL" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 34.3, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Aetna Medicare Advantage Plan", "plan_name": "Aetna Medicare Advantage Plan", "standard_charge_dollar": 34.31, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "All Savers", "plan_name": "All Savers", "standard_charge_dollar": 34.3, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Alliance Behavioral Health", "plan_name": "Alliance Behavioral Health", "standard_charge_dollar": 34.3, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "AmeriHealth Caritas Of NC Medicaid", "plan_name": "AmeriHealth Caritas Of NC Medicaid", "standard_charge_dollar": 33.27, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "BCBS STATE HEALTH PLAN", "plan_name": "BCBS STATE HEALTH PLAN", "standard_charge_dollar": 34.3, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "BCBSNC", "plan_name": "BCBSNC", "standard_charge_dollar": 34.3, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Blue Medicare Advantage Plan", "plan_name": "Blue Medicare Advantage Plan", "standard_charge_dollar": 34.3, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Cardinal Innovations", "plan_name": "Cardinal Innovations", "standard_charge_dollar": 34.3, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Carelon - Beacon Health Options", "plan_name": "Carelon - Beacon Health Options", "standard_charge_dollar": 34.3, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Carolina Complete Health Medicaid", "plan_name": "Carolina Complete Health Medicaid", "standard_charge_dollar": 33.27, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Centerpoint Human Services", "plan_name": "Centerpoint Human Services", "standard_charge_dollar": 34.3, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Cigna Behavioral Health", "plan_name": "Cigna Behavioral Health", "standard_charge_dollar": 34.3, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Cigna Great West", "plan_name": "Cigna Great West", "standard_charge_dollar": 34.3, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "CIGNA HEALTHCARE", "plan_name": "CIGNA HEALTHCARE", "standard_charge_dollar": 34.3, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "CIHA Cherokee Indian Hospital", "plan_name": "CIHA Cherokee Indian Hospital", "standard_charge_dollar": 34.3, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "CoastalCare", "plan_name": "CoastalCare", "standard_charge_dollar": 34.3, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Coventry Health", "plan_name": "Coventry Health", "standard_charge_dollar": 34.3, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Devoted Health, Inc.", "plan_name": "Devoted Health, Inc.", "standard_charge_dollar": 34.3, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "East Carolina Behavioral Health", "plan_name": "East Carolina Behavioral Health", "standard_charge_dollar": 37.73, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Eastpointe Human Services", "plan_name": "Eastpointe Human Services", "standard_charge_dollar": 35.33, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "GEHA Government Employee Health", "plan_name": "GEHA Government Employee Health", "standard_charge_dollar": 34.3, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Guardian", "plan_name": "Guardian", "standard_charge_dollar": 34.3, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Health Choice", "plan_name": "Health Choice", "standard_charge_dollar": 33.27, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "HealthSmart", "plan_name": "HealthSmart", "standard_charge_dollar": 34.3, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Healthy Blue BCBS Medicaid", "plan_name": "Healthy Blue BCBS Medicaid", "standard_charge_dollar": 34.72, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Humana Medicare", "plan_name": "Humana Medicare", "standard_charge_dollar": 34.3, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "MeckLink Behavioral Healthcare", "plan_name": "MeckLink Behavioral Healthcare", "standard_charge_dollar": 34.3, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "MedCost", "plan_name": "MedCost", "standard_charge_dollar": 34.3, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Medical Mutual Of Ohio", "plan_name": "Medical Mutual Of Ohio", "standard_charge_dollar": 34.3, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Optima Health VA Medicaid", "plan_name": "Optima Health VA Medicaid", "standard_charge_dollar": 52.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Optum Health", "plan_name": "Optum Health", "standard_charge_dollar": 34.3, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Partners Behavioral Health Management", "plan_name": "Partners Behavioral Health Management", "standard_charge_dollar": 34.22, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Physicians Mutual Insurance", "plan_name": "Physicians Mutual Insurance", "standard_charge_dollar": 34.3, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Sandhills Center", "plan_name": "Sandhills Center", "standard_charge_dollar": 4.85, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Trillium Health Resources", "plan_name": "Trillium Health Resources", "standard_charge_dollar": 37.73, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "UHC Community Plan Medicaid", "plan_name": "UHC Community Plan Medicaid", "standard_charge_dollar": 33.27, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "UHC Medicare Advantage Plan", "plan_name": "UHC Medicare Advantage Plan", "standard_charge_dollar": 34.3, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "UMR", "plan_name": "UMR", "standard_charge_dollar": 34.3, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health", "standard_charge_dollar": 34.3, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare", "standard_charge_dollar": 52.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Value Options", "plan_name": "Value Options", "standard_charge_dollar": 34.3, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Vaya Health", "plan_name": "Vaya Health", "standard_charge_dollar": 34.93, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Wellcare Of NC Medicaid", "plan_name": "Wellcare Of NC Medicaid", "standard_charge_dollar": 33.27, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Western Highlands", "plan_name": "Western Highlands", "standard_charge_dollar": 34.3, "methodology": "fee schedule", "additional_payer_notes": "" } ], "minimum": 4.85, "maximum": 52.0 } ] }, { "description": "Acute Adol R&B", "code_information": [ { "code": "124", "type": "RC" }, { "code": "1003", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Vaya Health", "plan_name": "Vaya Health", "standard_charge_dollar": 895.63, "methodology": "fee schedule", "additional_payer_notes": "" } ], "gross_charge": 3000.0, "minimum": 895.63, "maximum": 895.63 } ] }, { "description": "Acute Adult R&B", "code_information": [ { "code": "124", "type": "RC" }, { "code": "1001", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Vaya Health", "plan_name": "Vaya Health", "standard_charge_dollar": 895.63, "methodology": "fee schedule", "additional_payer_notes": "" } ], "gross_charge": 3000.0, "minimum": 895.63, "maximum": 895.63 } ] }, { "description": "Acute Psych Adult R&B", "code_information": [ { "code": "124", "type": "RC" }, { "code": "901", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Alliance Behavioral Health", "plan_name": "Alliance Behavioral Health", "standard_charge_dollar": 895.63, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "AmeriHealth Caritas Of NC Medicaid", "plan_name": "AmeriHealth Caritas Of NC Medicaid", "standard_charge_dollar": 895.63, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Carolina Complete Health Medicaid", "plan_name": "Carolina Complete Health Medicaid", "standard_charge_dollar": 895.63, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Healthy Blue BCBS Medicaid", "plan_name": "Healthy Blue BCBS Medicaid", "standard_charge_dollar": 895.63, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Partners Behavioral Health Management", "plan_name": "Partners Behavioral Health Management", "standard_charge_dollar": 895.63, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Trillium Health Resources", "plan_name": "Trillium Health Resources", "standard_charge_dollar": 913.54, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "UHC Community Plan Medicaid", "plan_name": "UHC Community Plan Medicaid", "standard_charge_dollar": 895.63, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Vaya Health", "plan_name": "Vaya Health", "standard_charge_dollar": 895.63, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Wellcare Of NC Medicaid", "plan_name": "Wellcare Of NC Medicaid", "standard_charge_dollar": 895.63, "methodology": "fee schedule", "additional_payer_notes": "" } ], "gross_charge": 3000.0, "minimum": 895.63, "maximum": 913.54 } ] }, { "description": "IP Acute Child/Adol", "code_information": [ { "code": "124", "type": "RC" }, { "code": "103200", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Medica", "plan_name": "Medica", "standard_charge_dollar": 750.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "PHCS", "plan_name": "PHCS", "standard_charge_dollar": 750.0, "methodology": "fee schedule", "additional_payer_notes": "" } ], "gross_charge": 3000.0, "discounted_cash": 653.3, "minimum": 750.0, "maximum": 750.0 } ] }, { "description": "R&B IP Acute Adol", "code_information": [ { "code": "124", "type": "RC" }, { "code": "620010", "type": "LOCAL" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "ACS Benefit Services", "plan_name": "ACS Benefit Services", "standard_charge_dollar": 478.3, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "AETNA", "plan_name": "AETNA", "standard_charge_dollar": 1045.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "All Savers", "plan_name": "All Savers", "standard_charge_dollar": 700.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Alliance Behavioral Health", "plan_name": "Alliance Behavioral Health", "standard_charge_dollar": 895.63, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Ambetter-Centene Carolina Community Heal", "plan_name": "Ambetter-Centene Carolina Community Heal", "standard_charge_dollar": 800.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "American Behavioral Systems", "plan_name": "American Behavioral Systems", "standard_charge_dollar": 850.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "AmeriHealth Caritas Of NC Medicaid", "plan_name": "AmeriHealth Caritas Of NC Medicaid", "standard_charge_dollar": 895.63, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Anthem Healthkeepers Plus - VA Medicaid", "plan_name": "Anthem Healthkeepers Plus - VA Medicaid", "standard_charge_dollar": 500.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "BCBS STATE HEALTH PLAN", "plan_name": "BCBS STATE HEALTH PLAN", "standard_charge_dollar": 1300.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "BCBSNC", "plan_name": "BCBSNC", "standard_charge_dollar": 908.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Blue Medicare Advantage Plan", "plan_name": "Blue Medicare Advantage Plan", "standard_charge_dollar": 675.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Bright Healthcare", "plan_name": "Bright Healthcare", "standard_charge_dollar": 800.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Cardinal Innovations", "plan_name": "Cardinal Innovations", "standard_charge_dollar": 597.88, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "CareFirst Community Health Plan Maryland", "plan_name": "CareFirst Community Health Plan Maryland", "standard_charge_dollar": 800.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Carelon - Beacon Health Options", "plan_name": "Carelon - Beacon Health Options", "standard_charge_dollar": 1034.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Carolina Behavioral Health Alliance", "plan_name": "Carolina Behavioral Health Alliance", "standard_charge_dollar": 720.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Carolina Complete Health Medicaid", "plan_name": "Carolina Complete Health Medicaid", "standard_charge_dollar": 895.63, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Centerpoint Human Services", "plan_name": "Centerpoint Human Services", "standard_charge_dollar": 478.3, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Cigna Behavioral Health", "plan_name": "Cigna Behavioral Health", "standard_charge_dollar": 1003.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Cigna Great West", "plan_name": "Cigna Great West", "standard_charge_dollar": 850.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "CIGNA HEALTHCARE", "plan_name": "CIGNA HEALTHCARE", "standard_charge_dollar": 1003.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Cigna Supplmental", "plan_name": "Cigna Supplmental", "standard_charge_dollar": 700.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "CIHA Cherokee Indian Hospital", "plan_name": "CIHA Cherokee Indian Hospital", "standard_charge_dollar": 741.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "CoastalCare", "plan_name": "CoastalCare", "standard_charge_dollar": 478.3, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Coresource", "plan_name": "Coresource", "standard_charge_dollar": 720.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Coventry Health", "plan_name": "Coventry Health", "standard_charge_dollar": 700.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Cypress Benefit Administrators", "plan_name": "Cypress Benefit Administrators", "standard_charge_dollar": 700.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Devoted Health, Inc.", "plan_name": "Devoted Health, Inc.", "standard_charge_dollar": 775.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "East Carolina Behavioral Health", "plan_name": "East Carolina Behavioral Health", "standard_charge_dollar": 478.3, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Eastpointe Human Services", "plan_name": "Eastpointe Human Services", "standard_charge_dollar": 823.98, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "First Carolina Care Insurance Company", "plan_name": "First Carolina Care Insurance Company", "standard_charge_dollar": 750.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Forsyth County DSS", "plan_name": "Forsyth County DSS", "standard_charge_dollar": 1850.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "GEHA Government Employee Health", "plan_name": "GEHA Government Employee Health", "standard_charge_dollar": 720.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "GHI", "plan_name": "GHI", "standard_charge_dollar": 720.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Golden Rule A United Healthcare Company", "plan_name": "Golden Rule A United Healthcare Company", "standard_charge_dollar": 1050.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Guardian", "plan_name": "Guardian", "standard_charge_dollar": 478.3, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Health Alliance", "plan_name": "Health Alliance", "standard_charge_dollar": 700.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Health Choice", "plan_name": "Health Choice", "standard_charge_dollar": 823.98, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Healthscope Benefits", "plan_name": "Healthscope Benefits", "standard_charge_dollar": 700.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "HealthSmart", "plan_name": "HealthSmart", "standard_charge_dollar": 478.3, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Healthy Blue BCBS Medicaid", "plan_name": "Healthy Blue BCBS Medicaid", "standard_charge_dollar": 895.63, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Humana", "plan_name": "Humana", "standard_charge_dollar": 1028.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Independence Administrators", "plan_name": "Independence Administrators", "standard_charge_dollar": 800.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Kaiser Permantente", "plan_name": "Kaiser Permantente", "standard_charge_dollar": 750.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "KY Medicaid - Anthem BCBS Medicaid", "plan_name": "KY Medicaid - Anthem BCBS Medicaid", "standard_charge_dollar": 500.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Luminare Health", "plan_name": "Luminare Health", "standard_charge_dollar": 985.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Magellan", "plan_name": "Magellan", "standard_charge_dollar": 1193.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Mail Handlers Benefit Plan", "plan_name": "Mail Handlers Benefit Plan", "standard_charge_dollar": 775.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "MeckLink Behavioral Healthcare", "plan_name": "MeckLink Behavioral Healthcare", "standard_charge_dollar": 478.3, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "MedCost", "plan_name": "MedCost", "standard_charge_dollar": 950.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Medica", "plan_name": "Medica", "standard_charge_dollar": 500.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Medical Mutual Of Ohio", "plan_name": "Medical Mutual Of Ohio", "standard_charge_dollar": 700.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Meritain Health", "plan_name": "Meritain Health", "standard_charge_dollar": 928.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "MVP HealthCare", "plan_name": "MVP HealthCare", "standard_charge_dollar": 800.0, "methodology": "fee schedule", 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}, { "payer_name": "Centerpoint Human Services", "plan_name": "Centerpoint Human Services", "standard_charge_dollar": 61.81, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Cigna Behavioral Health", "plan_name": "Cigna Behavioral Health", "standard_charge_dollar": 61.81, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Cigna Great West", "plan_name": "Cigna Great West", "standard_charge_dollar": 61.81, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "CIGNA HEALTHCARE", "plan_name": "CIGNA HEALTHCARE", "standard_charge_dollar": 61.81, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "CIHA Cherokee Indian Hospital", "plan_name": "CIHA Cherokee Indian Hospital", "standard_charge_dollar": 61.81, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "CoastalCare", "plan_name": "CoastalCare", "standard_charge_dollar": 61.81, "methodology": "fee 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"payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health", "standard_charge_dollar": 88.53, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "United Healthcare", "plan_name": "United Healthcare", "standard_charge_dollar": 120.0, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Value Options", "plan_name": "Value Options", "standard_charge_dollar": 88.53, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Vaya Health", "plan_name": "Vaya Health", "standard_charge_dollar": 115.38, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Wellcare Of NC Medicaid", "plan_name": "Wellcare Of NC Medicaid", "standard_charge_dollar": 97.01, "methodology": "fee schedule", "additional_payer_notes": "" }, { "payer_name": "Western Highlands", "plan_name": "Western Highlands", "standard_charge_dollar": 88.53, "methodology": "fee schedule", "additional_payer_notes": "" } ], "gross_charge": 200.0, "minimum": 85.87, "maximum": 120.0 } ] } ] }