{ "hospital_name": "SBH Colorado LLC", "location_name": [ "SBH Colorado LLC" ], "hospital_address": [ "7353 Sisters Grove, Colorado Springs, CO 80923" ], "type_2_npi": [ "1659524486" ], "license_information": { "license_number": "124", "state": "CO" }, "last_updated_on": "2026-03-31", "version": "3.0", "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": "Amy Alexander" }, "standard_charge_information": [ { "description": "PHP Adol/Child Psych 6hr", "code_information": [ { "code": "H0035", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 750.0, "discounted_cash_price": 750.0, "payer_specific_negotiated_charges": [ { "payer_name": "AARP Medicare Complete", "plan_name": "All Plans", "negotiated_rate": 227.92 }, { "payer_name": "Administrative District Council 1 Welfar", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Aetna", "plan_name": "All Plans", "negotiated_rate": 436.0 }, { "payer_name": "Aetna AMA Travel Insurance", "plan_name": "All Plans", "negotiated_rate": 435.0 }, { "payer_name": "Aetna Healthcare", "plan_name": "All Plans", "negotiated_rate": 542.0 }, { "payer_name": "Aetna Healthcare", "plan_name": "All Plans", "negotiated_rate": 558.0 }, { "payer_name": "Aetna Healthcare", "plan_name": "All Plans", "negotiated_rate": 575.0 }, { "payer_name": "Aetna Senior Supplemental Ins", "plan_name": "All Plans", "negotiated_rate": 435.0 }, { "payer_name": "Allegiance Benefit Plan", "plan_name": "All Plans", "negotiated_rate": 227.92 }, { "payer_name": "Allianz Global Assistance", "plan_name": "All Plans", "negotiated_rate": 227.92 }, { "payer_name": "Allied Benefits Systems", "plan_name": "All Plans", "negotiated_rate": 572.0 }, { "payer_name": "Allied Trades Assistance Program", "plan_name": "All Plans", "negotiated_rate": 300.0 }, { "payer_name": "Allsavers", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "Ameriben", "plan_name": "All Plans", "negotiated_rate": 255.0 }, { "payer_name": "American Family Ins", "plan_name": "All Plans", "negotiated_rate": 188.69 }, { "payer_name": "American Republic Insurance", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "AMFirst", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "Anthem BCBS Medicare Advantage", "plan_name": "All Plans", "negotiated_rate": 562.0 }, { "payer_name": "Anthem BCBS Personal Choice", "plan_name": "All Plans", "negotiated_rate": 578.86 }, { "payer_name": "Anthem Blue Cross Blue Shield", "plan_name": "All Plans", "negotiated_rate": 578.86 }, { "payer_name": "Anthem Medi Blue Of Ohio", "plan_name": "All Plans", "negotiated_rate": 578.86 }, { "payer_name": "Anthem Medi-Blue", "plan_name": "All Plans", "negotiated_rate": 578.86 }, { "payer_name": "Anthem Mediblue Dual Advantage", "plan_name": "All Plans", "negotiated_rate": 578.86 }, { "payer_name": "APWU Health Plan", "plan_name": "All Plans", "negotiated_rate": 375.0 }, { "payer_name": "ASR Health", "plan_name": "All Plans", "negotiated_rate": 431.0 }, { "payer_name": "Assurant Health", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Barrick Gold Corp", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Baylor Scott & White", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "BCBS HMO Colorado", "plan_name": "All Plans", "negotiated_rate": 546.0 }, { "payer_name": "Behavioral Health Inc", "plan_name": "All Plans", "negotiated_rate": 280.0 }, { "payer_name": "Bind Benefits, Inc", "plan_name": "All Plans", "negotiated_rate": 500.0 }, { "payer_name": "Blue Card Nasco", "plan_name": "All Plans", "negotiated_rate": 500.0 }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "All Plans", "negotiated_rate": 546.0 }, { "payer_name": "Bridge Point", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Bright Health Management", "plan_name": "All Plans", "negotiated_rate": 637.0 }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "All Plans", "negotiated_rate": 637.0 }, { "payer_name": "Care Source", "plan_name": "All Plans", "negotiated_rate": 227.92 }, { "payer_name": "Carelon Behavioral Health", "plan_name": "All Plans", "negotiated_rate": 420.98 }, { "payer_name": "Carelon Behavioral Health Strategies", "plan_name": "All Plans", "negotiated_rate": 420.98 }, { "payer_name": "Carelon BH APWU", "plan_name": "All Plans", "negotiated_rate": 420.98 }, { "payer_name": "Carelon BH Employee Asst", "plan_name": "All Plans", "negotiated_rate": 420.98 }, { "payer_name": "Carelon BH Great West", "plan_name": "All Plans", "negotiated_rate": 420.98 }, { "payer_name": "Carelon BH Kaiser", "plan_name": "All Plans", "negotiated_rate": 420.98 }, { "payer_name": "Carelon Health Colorado Medicaid", "plan_name": "All Plans", "negotiated_rate": 600.0 }, { "payer_name": "Carelon Medicare Advantage", "plan_name": "All Plans", "negotiated_rate": 420.98 }, { "payer_name": "Carelon Northeast Health Partners Mcaid", "plan_name": "All Plans", "negotiated_rate": 600.0 }, { "payer_name": "ChampVA", "plan_name": "All Plans", "negotiated_rate": 278.0 }, { "payer_name": "Cigna", "plan_name": "All Plans", "negotiated_rate": 503.0 }, { "payer_name": "Cigna Alliance Health And Life", "plan_name": "All Plans", "negotiated_rate": 503.0 }, { "payer_name": "Cigna Behavioral Health", "plan_name": "All Plans", "negotiated_rate": 503.0 }, { "payer_name": "Cigna Health Spring Medicare Advantage", "plan_name": "All Plans", "negotiated_rate": 503.0 }, { "payer_name": "Cigna International", "plan_name": "All Plans", "negotiated_rate": 503.0 }, { "payer_name": "Cigna Supplemental", "plan_name": "All Plans", "negotiated_rate": 503.0 }, { "payer_name": "Cigna True Choice Medicare PPO", "plan_name": "All Plans", "negotiated_rate": 503.0 }, { "payer_name": "Cigna Zenith Administrators", "plan_name": "All Plans", "negotiated_rate": 503.0 }, { "payer_name": "Cigna/GreatWest Healthcare", "plan_name": "All Plans", "negotiated_rate": 503.0 }, { "payer_name": "Cigna/Health Partners Inc", "plan_name": "All Plans", "negotiated_rate": 503.0 }, { "payer_name": "CNIC", "plan_name": "All Plans", "negotiated_rate": 450.0 }, { "payer_name": "Cofinity", "plan_name": "All Plans", "negotiated_rate": 436.0 }, { "payer_name": "Colo Community Health Alliance", "plan_name": "All Plans", "negotiated_rate": 359.04 }, { "payer_name": "Colorado Access", "plan_name": "All Plans", "negotiated_rate": 441.0 }, { "payer_name": "Colorado Access Advantage", "plan_name": "All Plans", "negotiated_rate": 291.0 }, { "payer_name": "Colorado Access CHP+", "plan_name": "All Plans", "negotiated_rate": 441.0 }, { "payer_name": "ComPsych", "plan_name": "All Plans", "negotiated_rate": 521.0 }, { "payer_name": "Continental Insurance - Marpai Health", "plan_name": "All Plans", "negotiated_rate": 463.0 }, { "payer_name": "Coventry Health Care", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Cover Colorado Rocky Mountain Health", "plan_name": "All Plans", "negotiated_rate": 435.6 }, { "payer_name": "Dean Health Plans", "plan_name": "All Plans", "negotiated_rate": 250.0 }, { "payer_name": "Denver Health DHHA", "plan_name": "All Plans", "negotiated_rate": 500.0 }, { "payer_name": "Denver Health Elevate Silver", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "Denver Health Med Plan Cofinity", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "Denver Health Medical Plan", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Deseret Healthcare Employee", "plan_name": "All Plans", "negotiated_rate": 227.92 }, { "payer_name": "EBMS", "plan_name": "All Plans", "negotiated_rate": 449.0 }, { "payer_name": "Enterprise Group Planning, Inc", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "Equitable Plan Services", "plan_name": "All Plans", "negotiated_rate": 350.0 }, { "payer_name": "Federal Blue Cross", "plan_name": "All Plans", "negotiated_rate": 578.86 }, { "payer_name": "First Choice Health Network", "plan_name": "All Plans", "negotiated_rate": 449.0 }, { "payer_name": "First Health", "plan_name": "All Plans", "negotiated_rate": 375.0 }, { "payer_name": "FMH Benefit Services", "plan_name": "All Plans", "negotiated_rate": 375.0 }, { "payer_name": "Friday Health Plans", "plan_name": "All Plans", "negotiated_rate": 523.0 }, { "payer_name": "GEHA", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "GEHA-Untied Hlth Integrated Serv", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "Golden Rule/UHC", "plan_name": "All Plans", "negotiated_rate": 255.0 }, { "payer_name": "Gravie Admin Service Aetna", "plan_name": "All Plans", "negotiated_rate": 526.0 }, { "payer_name": "Group Benefits", "plan_name": "All Plans", "negotiated_rate": 188.69 }, { "payer_name": "HAP Aetna", "plan_name": "All Plans", "negotiated_rate": 542.0 }, { "payer_name": "HAP Aetna", "plan_name": "All Plans", "negotiated_rate": 558.0 }, { "payer_name": "HAP Aetna", "plan_name": "All Plans", "negotiated_rate": 575.0 }, { "payer_name": "HCA Optum", "plan_name": "All Plans", "negotiated_rate": 293.0 }, { "payer_name": "Health Alliance", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "Health Management Concepts", "plan_name": "All Plans", "negotiated_rate": 500.0 }, { "payer_name": "Health Net Commercial Claims", "plan_name": "All Plans", "negotiated_rate": 359.0 }, { "payer_name": "HealthChoice", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "HealthComp Integrated Solutions LLC", "plan_name": "All Plans", "negotiated_rate": 542.0 }, { "payer_name": "HealthComp Integrated Solutions LLC", "plan_name": "All Plans", "negotiated_rate": 558.0 }, { "payer_name": "HealthComp Integrated Solutions LLC", "plan_name": "All Plans", "negotiated_rate": 575.0 }, { "payer_name": "HealthScope Benefits Inc", "plan_name": "All Plans", "negotiated_rate": 463.0 }, { "payer_name": "Humana Healthcare", "plan_name": "All Plans", "negotiated_rate": 500.0 }, { "payer_name": "Huntsman Mental Health Institute - BHN", "plan_name": "All Plans", "negotiated_rate": 578.86 }, { "payer_name": "HWBS Claims", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Imagine 360 Administrators", "plan_name": "All Plans", "negotiated_rate": 500.0 }, { "payer_name": "Kaiser Of Colorado", "plan_name": "All Plans", "negotiated_rate": 350.0 }, { "payer_name": "Kaiser Perm CHP", "plan_name": "All Plans", "negotiated_rate": 400.0 }, { "payer_name": "Kaiser Permanente", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Kaiser Permanente Denver", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Kaiser Permanente Northern", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Liberty Healthshare", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "Life Shield STM - Ins TPA", "plan_name": "All Plans", "negotiated_rate": 550.0 }, { "payer_name": "LINECO Mental Health & Substance Abuse", "plan_name": "All Plans", "negotiated_rate": 359.0 }, { "payer_name": "Lucent Health", "plan_name": "All Plans", "negotiated_rate": 550.0 }, { "payer_name": "Maestro Health", "plan_name": "All Plans", "negotiated_rate": 300.0 }, { "payer_name": "Magellan Devoted Health Plans", "plan_name": "All Plans", "negotiated_rate": 455.0 }, { "payer_name": "Magellan Health Services", "plan_name": "All Plans", "negotiated_rate": 455.0 }, { "payer_name": "Magellan Insurance", "plan_name": "All Plans", "negotiated_rate": 455.0 }, { "payer_name": "Mailhandlers", "plan_name": "All Plans", "negotiated_rate": 255.0 }, { "payer_name": "Managed Care Insurance - MBR Claims", "plan_name": "All Plans", "negotiated_rate": 500.0 }, { "payer_name": "Managed Health Network Group", "plan_name": "All Plans", "negotiated_rate": 255.0 }, { "payer_name": "Medica Elect", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "Medicaid United Healthcare", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "Medicare United HealthCare", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "Meritain Health", "plan_name": "All Plans", "negotiated_rate": 375.0 }, { "payer_name": "Meritain Health- Aetna Choice POS", "plan_name": "All Plans", "negotiated_rate": 542.0 }, { "payer_name": "Meritain Health- Aetna Choice POS", "plan_name": "All Plans", "negotiated_rate": 558.0 }, { "payer_name": "Meritain Health- Aetna Choice POS", "plan_name": "All Plans", "negotiated_rate": 575.0 }, { "payer_name": "MERP Administrative Services", "plan_name": "All Plans", "negotiated_rate": 250.0 }, { "payer_name": "MHNET", "plan_name": "All Plans", "negotiated_rate": 359.0 }, { "payer_name": "Mines And Associates, PC", "plan_name": "All Plans", "negotiated_rate": 450.0 }, { "payer_name": "Modern Assistance Program", "plan_name": "All Plans", "negotiated_rate": 600.0 }, { "payer_name": "Molina Healthcare Of Texas", "plan_name": "All Plans", "negotiated_rate": 450.0 }, { "payer_name": "Motivhealth", "plan_name": "All Plans", "negotiated_rate": 307.65 }, { "payer_name": "Mountain Health Co-op", "plan_name": "All Plans", "negotiated_rate": 578.86 }, { "payer_name": "Multiplan", "plan_name": "All Plans", "negotiated_rate": 550.0 }, { "payer_name": "NALC Health Benefit Plan", "plan_name": "All Plans", "negotiated_rate": 486.0 }, { "payer_name": "Nationwide Life", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Neighborhood Health Plan", "plan_name": "All Plans", "negotiated_rate": 350.0 }, { "payer_name": "New Mexico Medicaid", "plan_name": "All Plans", "negotiated_rate": 530.0 }, { "payer_name": "Nikola Tesia Alternative High School", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Northeast HP- RMHP", "plan_name": "All Plans", "negotiated_rate": 373.5 }, { "payer_name": "OPTUM EMPIRE HEALTH PLAN", "plan_name": "All Plans", "negotiated_rate": 255.0 }, { "payer_name": "Optum Health Behavioral Solutions", "plan_name": "All Plans", "negotiated_rate": 260.0 }, { "payer_name": "Oxford Health - United Behavioral Health", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "ParkCare Plus", "plan_name": "All Plans", "negotiated_rate": 600.0 }, { "payer_name": "Physicians Mutual Insurance Company", "plan_name": "All Plans", "negotiated_rate": 359.0 }, { "payer_name": "Preferred One Administrative Services", "plan_name": "All Plans", "negotiated_rate": 350.0 }, { "payer_name": "Provider Network Of America", "plan_name": "All Plans", "negotiated_rate": 324.77 }, { "payer_name": "Reserve Officers Assoc Insurance", "plan_name": "All Plans", "negotiated_rate": 359.0 }, { "payer_name": "RMHP HMO Optum", "plan_name": "All Plans", "negotiated_rate": 600.0 }, { "payer_name": "RMSCO, Inc", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Rocky Mountain Health Plans Medicaid", "plan_name": "All Plans", "negotiated_rate": 373.5 }, { "payer_name": "Rocky Mountain Human Services", "plan_name": "All Plans", "negotiated_rate": 291.0 }, { "payer_name": "Rocky Mountain-Life Strategies", "plan_name": "All Plans", "negotiated_rate": 255.0 }, { "payer_name": "Routt County Jail & Detention Center", "plan_name": "All Plans", "negotiated_rate": 500.0 }, { "payer_name": "Sanford Health Ins - Multiplan", "plan_name": "All Plans", "negotiated_rate": 500.0 }, { "payer_name": "Select Benefits Administrators", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Select Health Insurance", "plan_name": "All Plans", "negotiated_rate": 400.0 }, { "payer_name": "Select Health Medicare Adv", "plan_name": "All Plans", "negotiated_rate": 400.0 }, { "payer_name": "Selman And Company", "plan_name": "All Plans", "negotiated_rate": 273.0 }, { "payer_name": "Selman Co", "plan_name": "All Plans", "negotiated_rate": 255.0 }, { "payer_name": "Sheet Metal Workers", "plan_name": "All Plans", "negotiated_rate": 359.0 }, { "payer_name": "Shelter Point", "plan_name": "All Plans", "negotiated_rate": 500.0 }, { "payer_name": "Simplan Insurance", "plan_name": "All Plans", "negotiated_rate": 400.0 }, { "payer_name": "Simplified Benefits Administrators", "plan_name": "All Plans", "negotiated_rate": 750.0 }, { "payer_name": "Standard Life And Accident Insurance", "plan_name": "All Plans", "negotiated_rate": 350.0 }, { "payer_name": "Starmark Insurance", "plan_name": "All Plans", "negotiated_rate": 436.0 }, { "payer_name": "State Of Co Probation", "plan_name": "All Plans", "negotiated_rate": 578.86 }, { "payer_name": "Surest - United Health Care", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "TLC Benefits Solution Inc.", "plan_name": "All Plans", "negotiated_rate": 500.0 }, { "payer_name": "Travelers Insurance", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Tricare North Region", "plan_name": "All Plans", "negotiated_rate": 227.92 }, { "payer_name": "Tricare Pacific Region 14", "plan_name": "All Plans", "negotiated_rate": 227.92 }, { "payer_name": "Tricare South Region", "plan_name": "All Plans", "negotiated_rate": 227.92 }, { "payer_name": "Trustmark Small Business Benefits", "plan_name": "All Plans", "negotiated_rate": 436.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "All Plans", "negotiated_rate": 479.0 }, { "payer_name": "UMR", "plan_name": "All Plans", "negotiated_rate": 260.0 }, { "payer_name": "UMR/CEBT-PM085516", "plan_name": "All Plans", "negotiated_rate": 260.0 }, { "payer_name": "UMR/United Healthcare", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "United American Insurance CO", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "United Behavioral Health", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "United Behavioral Health Of California", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "United Health Care", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "United Health Care New Mexico", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "United Healthcare Student Resources", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "United Healthcare Supplement", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "United Select Health", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "United World Life", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "UPMC Health Plan", "plan_name": "All Plans", "negotiated_rate": 486.0 }, { "payer_name": "Wellfleet", "plan_name": "All Plans", "negotiated_rate": 550.0 }, { "payer_name": "Winhealth", "plan_name": "All Plans", "negotiated_rate": 350.0 } ], "minimum": 188.69, "maximum": 750.0 } ] }, { "description": "Adult Psych PHP 6 hrs", "code_information": [ { "code": "H0035", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 750.0, "discounted_cash_price": 750.0, "payer_specific_negotiated_charges": [ { "payer_name": "AARP Medicare Complete", "plan_name": "All Plans", "negotiated_rate": 227.92 }, { "payer_name": "Administrative District Council 1 Welfar", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Aetna", "plan_name": "All Plans", "negotiated_rate": 436.0 }, { "payer_name": "Aetna AMA Travel Insurance", "plan_name": "All Plans", "negotiated_rate": 436.0 }, { "payer_name": "Aetna Healthcare", "plan_name": "All Plans", "negotiated_rate": 542.0 }, { "payer_name": "Aetna Healthcare", "plan_name": "All Plans", "negotiated_rate": 558.0 }, { "payer_name": "Aetna Healthcare", "plan_name": "All Plans", "negotiated_rate": 575.0 }, { "payer_name": "Aetna Senior Supplemental Ins", "plan_name": "All Plans", "negotiated_rate": 436.0 }, { "payer_name": "Allegiance Benefit Plan", "plan_name": "All Plans", "negotiated_rate": 227.92 }, { "payer_name": "Allianz Global Assistance", "plan_name": "All Plans", "negotiated_rate": 227.92 }, { "payer_name": "Allied Benefits Systems", "plan_name": "All Plans", "negotiated_rate": 572.0 }, { "payer_name": "Allied Trades Assistance Program", "plan_name": "All Plans", "negotiated_rate": 300.0 }, { "payer_name": "Allsavers", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "Ameriben", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "American Family Ins", "plan_name": "All Plans", "negotiated_rate": 188.69 }, { "payer_name": "American Republic Insurance", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "AMFirst", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "Anthem BCBS Medicare Advantage", "plan_name": "All Plans", "negotiated_rate": 562.0 }, { "payer_name": "Anthem BCBS Personal Choice", "plan_name": "All Plans", "negotiated_rate": 578.86 }, { "payer_name": "Anthem Blue Cross Blue Shield", "plan_name": "All Plans", "negotiated_rate": 578.86 }, { "payer_name": "Anthem Medi Blue Of Ohio", "plan_name": "All Plans", "negotiated_rate": 578.86 }, { "payer_name": "Anthem Medi-Blue", "plan_name": "All Plans", "negotiated_rate": 578.86 }, { "payer_name": "Anthem Mediblue Dual Advantage", "plan_name": "All Plans", "negotiated_rate": 578.86 }, { "payer_name": "APWU Health Plan", "plan_name": "All Plans", "negotiated_rate": 375.0 }, { "payer_name": "Arapahoe County Dept Of Human Services", "plan_name": "All Plans", "negotiated_rate": 280.0 }, { "payer_name": "ASR Health", "plan_name": "All Plans", "negotiated_rate": 431.0 }, { "payer_name": "Assurant Health", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Barrick Gold Corp", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Baylor Scott & White", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "BCBS HMO Colorado", "plan_name": "All Plans", "negotiated_rate": 546.0 }, { "payer_name": "Behavioral Health Inc", "plan_name": "All Plans", "negotiated_rate": 280.0 }, { "payer_name": "Bind Benefits, Inc", "plan_name": "All Plans", "negotiated_rate": 500.0 }, { "payer_name": "Blue Card Nasco", "plan_name": "All Plans", "negotiated_rate": 500.0 }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "All Plans", "negotiated_rate": 645.0 }, { "payer_name": "Bridge Point", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Bright Health Management", "plan_name": "All Plans", "negotiated_rate": 637.0 }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "All Plans", "negotiated_rate": 637.0 }, { 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}, { "payer_name": "Mitchell International", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Modern Assistance Program", "plan_name": "All Plans", "negotiated_rate": 600.0 }, { "payer_name": "Molina Healthcare Of Texas", "plan_name": "All Plans", "negotiated_rate": 450.0 }, { "payer_name": "Motivhealth", "plan_name": "All Plans", "negotiated_rate": 307.65 }, { "payer_name": "Mountain Health Co-op", "plan_name": "All Plans", "negotiated_rate": 578.86 }, { "payer_name": "Multiplan", "plan_name": "All Plans", "negotiated_rate": 550.0 }, { "payer_name": "New Mexico Medicaid", "plan_name": "All Plans", "negotiated_rate": 530.0 }, { "payer_name": "Northeast HP- RMHP", "plan_name": "All Plans", "negotiated_rate": 373.5 }, { "payer_name": "OPTUM EMPIRE HEALTH PLAN", "plan_name": "All Plans", "negotiated_rate": 255.0 }, { "payer_name": "Optum Health Behavioral Solutions", "plan_name": "All Plans", "negotiated_rate": 260.0 }, { "payer_name": "Oxford Health - United Behavioral Health", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "Pacificare Behavioral Health", "plan_name": "All Plans", "negotiated_rate": 273.0 }, { "payer_name": "ParkCare Plus", "plan_name": "All Plans", "negotiated_rate": 600.0 }, { "payer_name": "Physicians Mutual Insurance Company", "plan_name": "All Plans", "negotiated_rate": 359.0 }, { "payer_name": "Preferred One Administrative Services", "plan_name": "All Plans", "negotiated_rate": 350.0 }, { "payer_name": "Priority Health Insurance", "plan_name": "All Plans", "negotiated_rate": 500.0 }, { "payer_name": "Provider Network Of America", "plan_name": "All Plans", "negotiated_rate": 324.77 }, { "payer_name": "Reserve Officers Assoc Insurance", "plan_name": "All Plans", "negotiated_rate": 359.0 }, { "payer_name": "RMHP Commercial Optun", "plan_name": "All Plans", "negotiated_rate": 710.7 }, { "payer_name": "RMHP HMO Optum", "plan_name": "All Plans", "negotiated_rate": 600.0 }, { "payer_name": "RMHP Medicare Optum", "plan_name": "All Plans", "negotiated_rate": 235.0 }, { "payer_name": "RMSCO, Inc", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Rocky Mountain Health Plans Medicaid", "plan_name": "All Plans", "negotiated_rate": 373.5 }, { "payer_name": "Rocky Mountain-Life Strategies", "plan_name": "All Plans", "negotiated_rate": 255.0 }, { "payer_name": "Routt County Jail & Detention Center", "plan_name": "All Plans", "negotiated_rate": 500.0 }, { "payer_name": "Sanford Health Ins - Multiplan", "plan_name": "All Plans", "negotiated_rate": 500.0 }, { "payer_name": "SECURE HORIZONS", "plan_name": "All Plans", "negotiated_rate": 227.92 }, { "payer_name": "Secure Horizons Direct", "plan_name": "All Plans", "negotiated_rate": 273.0 }, { "payer_name": "Select Benefits Administrators", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Select Health Insurance", "plan_name": "All Plans", "negotiated_rate": 400.0 }, { "payer_name": "Select Health Medicare Adv", "plan_name": "All Plans", "negotiated_rate": 400.0 }, { "payer_name": "Selman And Company", "plan_name": "All Plans", "negotiated_rate": 273.0 }, { "payer_name": "Selman Co", "plan_name": "All Plans", "negotiated_rate": 255.0 }, { "payer_name": "Sheet Metal Workers", "plan_name": "All Plans", "negotiated_rate": 359.0 }, { "payer_name": "Shelter Point", "plan_name": "All Plans", "negotiated_rate": 500.0 }, { "payer_name": "Simplan Insurance", "plan_name": "All Plans", "negotiated_rate": 400.0 }, { "payer_name": "Simplified Benefits Administrators", "plan_name": "All Plans", "negotiated_rate": 750.0 }, { "payer_name": "Starmark Insurance", "plan_name": "All Plans", "negotiated_rate": 436.0 }, { "payer_name": "State Of Co Probation", "plan_name": "All Plans", "negotiated_rate": 578.86 }, { "payer_name": "Surest - United Health Care", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "TLC Benefits Solution Inc.", "plan_name": "All Plans", "negotiated_rate": 500.0 }, { "payer_name": "Travelers Insurance", "plan_name": "All Plans", "negotiated_rate": 224.27 }, { "payer_name": "Tricare North Region", "plan_name": "All Plans", "negotiated_rate": 227.92 }, { "payer_name": "Tricare Pacific Region 14", "plan_name": "All Plans", "negotiated_rate": 227.92 }, { "payer_name": "Tricare South Region", "plan_name": "All Plans", "negotiated_rate": 227.92 }, { "payer_name": "Trustmark Small Business Benefits", "plan_name": "All Plans", "negotiated_rate": 436.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "All Plans", "negotiated_rate": 479.0 }, { "payer_name": "UMR", "plan_name": "All Plans", "negotiated_rate": 273.0 }, { "payer_name": "UMR/CEBT-PM085516", "plan_name": "All Plans", "negotiated_rate": 260.0 }, { "payer_name": "UMR/United Healthcare", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "United American Insurance CO", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "United 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Health Plans", "plan_name": "All Plans", "negotiated_rate": 293.0 }, { "payer_name": "Employers Health Network", "plan_name": "All Plans", "negotiated_rate": 302.0 }, { "payer_name": "Enterprise Group Planning, Inc", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "Federal Blue Cross", "plan_name": "All Plans", "negotiated_rate": 231.75 }, { "payer_name": "Gravie Admin Service Aetna", "plan_name": "All Plans", "negotiated_rate": 293.0 }, { "payer_name": "HAP Aetna", "plan_name": "All Plans", "negotiated_rate": 302.0 }, { "payer_name": "HAP Aetna", "plan_name": "All Plans", "negotiated_rate": 311.0 }, { "payer_name": "HAP Aetna", "plan_name": "All Plans", "negotiated_rate": 320.0 }, { "payer_name": "HealthComp Integrated Solutions LLC", "plan_name": "All Plans", "negotiated_rate": 302.0 }, { "payer_name": "HealthComp Integrated Solutions LLC", "plan_name": "All Plans", "negotiated_rate": 311.0 }, { "payer_name": "HealthComp Integrated Solutions LLC", "plan_name": 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Plans", "negotiated_rate": 450.0 }, { "payer_name": "Rocky Mountain Health Plans Medicaid", "plan_name": "All Plans", "negotiated_rate": 450.0 }, { "payer_name": "State Of Co Probation", "plan_name": "All Plans", "negotiated_rate": 275.0 }, { "payer_name": "Triwest Tricare", "plan_name": "All Plans", "negotiated_rate": 398.0 }, { "payer_name": "UMR/United Healthcare", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "United Behavioral Health", "plan_name": "All Plans", "negotiated_rate": 165.0 } ], "minimum": 165.0, "maximum": 450.0 } ] }, { "description": "Telehealth Tri/Medi Psych Adult IOP-2 units", "code_information": [ { "code": "90853", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 320.0, "discounted_cash_price": 320.0, "payer_specific_negotiated_charges": [ { "payer_name": "Aetna Medicare Advantage", "plan_name": "All Plans", "negotiated_rate": 302.0 }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "All Plans", "negotiated_rate": 311.0 }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "All Plans", "negotiated_rate": 320.0 } ], "minimum": 302.0, "maximum": 320.0 } ] }, { "description": "Telehealth Tri/Medi Psych Adult IOP-3 units", "code_information": [ { "code": "90853", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 320.0, "discounted_cash_price": 320.0, "payer_specific_negotiated_charges": [ { "payer_name": "Aetna Medicare Advantage", "plan_name": "All Plans", "negotiated_rate": 302.0 }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "All Plans", "negotiated_rate": 311.0 }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "All Plans", "negotiated_rate": 320.0 } ], "minimum": 302.0, "maximum": 320.0 } ] }, { "description": "Tri/Medi Child/Adol PHP - 1 un", "code_information": [ { "code": "G0411", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 546.0, "discounted_cash_price": 546.0, "payer_specific_negotiated_charges": [ { "payer_name": "AARP Medicare Complete", "plan_name": "All Plans", "negotiated_rate": 227.92 }, { "payer_name": "Administrative District Council 1 Welfar", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Aetna Healthcare", "plan_name": "All Plans", "negotiated_rate": 375.0 }, { "payer_name": "Allegiance Benefit Plan", "plan_name": "All Plans", "negotiated_rate": 227.92 }, { "payer_name": "Allianz Global Assistance", "plan_name": "All Plans", "negotiated_rate": 270.26 }, { "payer_name": "Ameriben", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "American Family Ins", "plan_name": "All Plans", "negotiated_rate": 188.69 }, { "payer_name": "American Republic Insurance", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Anthem BCBS Personal Choice", "plan_name": "All Plans", "negotiated_rate": 500.0 }, { "payer_name": "Anthem Blue Cross Blue Shield", "plan_name": "All Plans", 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"negotiated_rate": 345.0 }, { "payer_name": "Cover Colorado Rocky Mountain Health", "plan_name": "All Plans", "negotiated_rate": 435.6 }, { "payer_name": "Denver Health Medical Plan", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Deseret Healthcare Employee", "plan_name": "All Plans", "negotiated_rate": 227.92 }, { "payer_name": "EBMS", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "First Health", "plan_name": "All Plans", "negotiated_rate": 375.0 }, { "payer_name": "FMH Benefit Services", "plan_name": "All Plans", "negotiated_rate": 375.0 }, { "payer_name": "GEHA", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "GEHA-Untied Hlth Integrated Serv", "plan_name": "All Plans", "negotiated_rate": 255.0 }, { "payer_name": "Golden Rule/UHC", "plan_name": "All Plans", "negotiated_rate": 255.0 }, { "payer_name": "Group Benefits", "plan_name": "All Plans", "negotiated_rate": 188.69 }, { "payer_name": "HealthChoice", 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{ "payer_name": "Tricare South Region", "plan_name": "All Plans", "negotiated_rate": 167.11 }, { "payer_name": "Tricare West-United Healthcare", "plan_name": "All Plans", "negotiated_rate": 167.11 }, { "payer_name": "Tricare-WPS", "plan_name": "All Plans", "negotiated_rate": 175.9 }, { "payer_name": "Triwest Tricare", "plan_name": "All Plans", "negotiated_rate": 530.0 } ], "minimum": 167.11, "maximum": 546.0 } ] }, { "description": "Tri/Medi Child/Adol PHP - 2 un", "code_information": [ { "code": "G0411", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 500.0, "discounted_cash_price": 500.0, "payer_specific_negotiated_charges": [ { "payer_name": "AARP Medicare Complete", "plan_name": "All Plans", "negotiated_rate": 227.92 }, { "payer_name": "Administrative District Council 1 Welfar", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Aetna Healthcare", "plan_name": "All Plans", "negotiated_rate": 375.0 }, { "payer_name": "Allegiance Benefit Plan", "plan_name": "All Plans", "negotiated_rate": 227.92 }, { "payer_name": "Allianz Global Assistance", "plan_name": "All Plans", "negotiated_rate": 135.13 }, { "payer_name": "Ameriben", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "American Family Ins", "plan_name": "All Plans", "negotiated_rate": 188.69 }, { "payer_name": "American Republic Insurance", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Anthem BCBS Personal Choice", "plan_name": "All Plans", "negotiated_rate": 500.0 }, { "payer_name": "Anthem Blue Cross Blue Shield", "plan_name": "All Plans", "negotiated_rate": 500.0 }, { "payer_name": "Anthem Medi Blue Of Ohio", "plan_name": "All Plans", "negotiated_rate": 500.0 }, { "payer_name": "Anthem Medi-Blue", "plan_name": "All Plans", "negotiated_rate": 500.0 }, { "payer_name": "Anthem Mediblue Dual Advantage", "plan_name": "All Plans", "negotiated_rate": 500.0 }, { "payer_name": "APWU Health Plan", "plan_name": "All Plans", "negotiated_rate": 375.0 }, { "payer_name": "Assurant Health", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Barrick Gold Corp", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Behavioral Health Inc", "plan_name": "All Plans", "negotiated_rate": 280.0 }, { "payer_name": "Blue Card Nasco", "plan_name": "All Plans", "negotiated_rate": 500.0 }, { "payer_name": "Bridge Point", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Care Source", "plan_name": "All Plans", "negotiated_rate": 227.92 }, { "payer_name": "ChampVA", "plan_name": "All Plans", "negotiated_rate": 227.92 }, { "payer_name": "Cigna", "plan_name": "All Plans", "negotiated_rate": 375.0 }, { "payer_name": "Cigna Behavioral Health", "plan_name": "All Plans", "negotiated_rate": 375.0 }, { "payer_name": "Cigna International", "plan_name": "All Plans", "negotiated_rate": 375.0 }, { "payer_name": "Cigna/GreatWest Healthcare", "plan_name": "All Plans", "negotiated_rate": 375.0 }, { "payer_name": "Cigna/Health Partners Inc", "plan_name": "All Plans", "negotiated_rate": 375.0 }, { "payer_name": "CNIC", "plan_name": "All Plans", "negotiated_rate": 450.0 }, { "payer_name": "Cofinity", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Colorado Access", "plan_name": "All Plans", "negotiated_rate": 280.0 }, { "payer_name": "Colorado Access Advantage", "plan_name": "All Plans", "negotiated_rate": 280.0 }, { "payer_name": "Coventry Health Care", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Cover Colorado Rocky Mountain Health", "plan_name": "All Plans", "negotiated_rate": 435.6 }, { "payer_name": "Denver Health Medical Plan", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Deseret Healthcare Employee", "plan_name": "All Plans", "negotiated_rate": 227.92 }, { "payer_name": "EBMS", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "First Health", "plan_name": "All Plans", "negotiated_rate": 375.0 }, { "payer_name": "FMH Benefit Services", "plan_name": "All Plans", "negotiated_rate": 375.0 }, { "payer_name": "GEHA", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "GEHA-Untied Hlth Integrated Serv", "plan_name": "All Plans", "negotiated_rate": 255.0 }, { "payer_name": "Golden Rule/UHC", "plan_name": "All Plans", "negotiated_rate": 255.0 }, { "payer_name": "Group Benefits", "plan_name": "All Plans", "negotiated_rate": 188.69 }, { "payer_name": "HealthChoice", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "HealthScope Benefits Inc", "plan_name": "All Plans", "negotiated_rate": 375.0 }, { "payer_name": "HNFS Tricare West", "plan_name": "All Plans", "negotiated_rate": 265.0 }, { "payer_name": "Humana Gold Choice", "plan_name": "All Plans", "negotiated_rate": 94.34 }, { "payer_name": "Humana Healthcare", "plan_name": "All Plans", "negotiated_rate": 500.0 }, { "payer_name": "Maestro Health", "plan_name": "All Plans", "negotiated_rate": 375.0 }, { "payer_name": "Medicare United HealthCare", "plan_name": "All Plans", "negotiated_rate": 227.92 }, { "payer_name": "Tricare Europe Region 13", "plan_name": "All Plans", "negotiated_rate": 83.55 }, { "payer_name": "TriCare For Life", "plan_name": "All Plans", "negotiated_rate": 167.11 }, { "payer_name": "Tricare North Region", "plan_name": "All Plans", "negotiated_rate": 83.55 }, { "payer_name": "Tricare Pacific Region 14", "plan_name": "All Plans", "negotiated_rate": 83.55 }, { "payer_name": "Tricare South Region", "plan_name": "All Plans", "negotiated_rate": 83.55 }, { "payer_name": "Tricare West-United Healthcare", "plan_name": "All Plans", "negotiated_rate": 65.79 }, { "payer_name": "Tricare-WPS", "plan_name": "All Plans", "negotiated_rate": 175.9 }, { "payer_name": "Triwest Tricare", "plan_name": "All Plans", "negotiated_rate": 265.0 } ], "minimum": 65.79, "maximum": 500.0 } ] }, { "description": "Tri/Medi Child/Adol PHP - 3 un", "code_information": [ { "code": "G0411", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 500.0, "discounted_cash_price": 500.0, "payer_specific_negotiated_charges": [ { "payer_name": "AARP Medicare Complete", "plan_name": "All Plans", "negotiated_rate": 227.92 }, { "payer_name": "Administrative District Council 1 Welfar", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Aetna Healthcare", "plan_name": "All Plans", "negotiated_rate": 375.0 }, { "payer_name": "Allegiance Benefit Plan", "plan_name": "All Plans", "negotiated_rate": 227.92 }, { "payer_name": "Allianz Global Assistance", "plan_name": "All Plans", "negotiated_rate": 90.09 }, { "payer_name": "Ameriben", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "American Family Ins", "plan_name": "All Plans", "negotiated_rate": 188.69 }, { "payer_name": "American Republic Insurance", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Anthem BCBS Personal Choice", "plan_name": "All Plans", "negotiated_rate": 500.0 }, { "payer_name": "Anthem Blue Cross Blue Shield", "plan_name": "All Plans", "negotiated_rate": 500.0 }, { "payer_name": "Anthem Medi Blue Of Ohio", "plan_name": "All Plans", "negotiated_rate": 500.0 }, { "payer_name": "Anthem Medi-Blue", "plan_name": "All Plans", "negotiated_rate": 500.0 }, { "payer_name": "Anthem Mediblue Dual Advantage", "plan_name": "All Plans", "negotiated_rate": 500.0 }, { "payer_name": "APWU Health Plan", "plan_name": "All Plans", "negotiated_rate": 375.0 }, { "payer_name": "Assurant Health", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Barrick Gold Corp", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Behavioral Health Inc", "plan_name": "All Plans", "negotiated_rate": 280.0 }, { "payer_name": "Blue Card Nasco", "plan_name": "All Plans", "negotiated_rate": 500.0 }, { "payer_name": "Bridge Point", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Care Source", "plan_name": "All Plans", "negotiated_rate": 227.92 }, { "payer_name": "ChampVA", "plan_name": "All Plans", "negotiated_rate": 227.92 }, { "payer_name": "Cigna", "plan_name": "All Plans", "negotiated_rate": 375.0 }, { "payer_name": "Cigna Behavioral Health", "plan_name": "All Plans", "negotiated_rate": 375.0 }, { "payer_name": "Cigna International", "plan_name": "All Plans", "negotiated_rate": 375.0 }, { "payer_name": "Cigna/GreatWest Healthcare", "plan_name": "All Plans", "negotiated_rate": 375.0 }, { "payer_name": "Cigna/Health Partners Inc", "plan_name": "All Plans", "negotiated_rate": 375.0 }, { "payer_name": "CNIC", "plan_name": "All Plans", "negotiated_rate": 450.0 }, { "payer_name": "Cofinity", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Colorado Access", "plan_name": "All Plans", "negotiated_rate": 280.0 }, { "payer_name": "Colorado Access Advantage", "plan_name": "All Plans", "negotiated_rate": 280.0 }, { "payer_name": "Coventry Health Care", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Cover Colorado Rocky Mountain Health", "plan_name": "All Plans", "negotiated_rate": 435.6 }, { "payer_name": "Denver Health Medical Plan", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Deseret Healthcare Employee", "plan_name": "All Plans", "negotiated_rate": 227.92 }, { "payer_name": "EBMS", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "First Health", "plan_name": "All Plans", "negotiated_rate": 375.0 }, { "payer_name": "FMH Benefit Services", "plan_name": "All Plans", "negotiated_rate": 375.0 }, { "payer_name": "GEHA", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "GEHA-Untied Hlth Integrated Serv", "plan_name": "All Plans", "negotiated_rate": 255.0 }, { "payer_name": "Golden Rule/UHC", "plan_name": "All Plans", "negotiated_rate": 255.0 }, { "payer_name": "Group Benefits", 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500.0, "payer_specific_negotiated_charges": [ { "payer_name": "AARP Medicare Complete", "plan_name": "All Plans", "negotiated_rate": 227.92 }, { "payer_name": "Administrative District Council 1 Welfar", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Aetna Healthcare", "plan_name": "All Plans", "negotiated_rate": 375.0 }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "All Plans", "negotiated_rate": 90.09 }, { "payer_name": "Allegiance Benefit Plan", "plan_name": "All Plans", "negotiated_rate": 227.92 }, { "payer_name": "Allianz Global Assistance", "plan_name": "All Plans", "negotiated_rate": 90.09 }, { "payer_name": "Ameriben", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "American Family Ins", "plan_name": "All Plans", "negotiated_rate": 188.69 }, { "payer_name": "American Republic Insurance", "plan_name": "All Plans", "negotiated_rate": 345.0 }, { "payer_name": "Anthem BCBS Personal Choice", "plan_name": "All Plans", 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{ "payer_name": "Allsavers", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "American Republic Corp Ins", "plan_name": "All Plans", "negotiated_rate": 449.0 }, { "payer_name": "AMFirst", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "Anthem BCBS Medicare Advantage", "plan_name": "All Plans", "negotiated_rate": 562.0 }, { "payer_name": "Anthem BCBS Personal Choice", "plan_name": "All Plans", "negotiated_rate": 578.86 }, { "payer_name": "Anthem Blue Cross Blue Shield", "plan_name": "All Plans", "negotiated_rate": 578.86 }, { "payer_name": "Anthem Medi Blue Of Ohio", "plan_name": "All Plans", "negotiated_rate": 578.86 }, { "payer_name": "Anthem Medi-Blue", "plan_name": "All Plans", "negotiated_rate": 578.86 }, { "payer_name": "Anthem Mediblue Dual Advantage", "plan_name": "All Plans", "negotiated_rate": 578.86 }, { "payer_name": "ASR Health", "plan_name": "All Plans", "negotiated_rate": 431.0 }, { "payer_name": "Baylor Scott & White", 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}, { "payer_name": "Molina Healthcare Of Texas", "plan_name": "All Plans", "negotiated_rate": 450.0 }, { "payer_name": "Motivhealth", "plan_name": "All Plans", "negotiated_rate": 307.65 }, { "payer_name": "Mountain Health Co-op", "plan_name": "All Plans", "negotiated_rate": 578.86 }, { "payer_name": "New Mexico Medicaid", "plan_name": "All Plans", "negotiated_rate": 530.0 }, { "payer_name": "Northeast HP- RMHP", "plan_name": "All Plans", "negotiated_rate": 373.5 }, { "payer_name": "Optum Health Behavioral Solutions", "plan_name": "All Plans", "negotiated_rate": 260.0 }, { "payer_name": "Oxford Health - United Behavioral Health", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "Pacificare Behavioral Health", "plan_name": "All Plans", "negotiated_rate": 273.0 }, { "payer_name": "ParkCare Plus", "plan_name": "All Plans", "negotiated_rate": 600.0 }, { "payer_name": "Provider Network Of America", "plan_name": "All Plans", "negotiated_rate": 324.77 }, { "payer_name": "RMHP Medicare Optum", "plan_name": "All Plans", "negotiated_rate": 235.0 }, { "payer_name": "Routt County Jail & Detention Center", "plan_name": "All Plans", "negotiated_rate": 500.0 }, { "payer_name": "Secure Horizons Direct", "plan_name": "All Plans", "negotiated_rate": 273.0 }, { "payer_name": "Select Health Insurance", "plan_name": "All Plans", "negotiated_rate": 400.0 }, { "payer_name": "Select Health Medicare Adv", "plan_name": "All Plans", "negotiated_rate": 400.0 }, { "payer_name": "Selman And Company", "plan_name": "All Plans", "negotiated_rate": 273.0 }, { "payer_name": "Shelter Point", "plan_name": "All Plans", "negotiated_rate": 500.0 }, { "payer_name": "Simplan Insurance", "plan_name": "All Plans", "negotiated_rate": 400.0 }, { "payer_name": "Simplified Benefits Administrators", "plan_name": "All Plans", "negotiated_rate": 750.0 }, { "payer_name": "Starmark Insurance", "plan_name": "All Plans", "negotiated_rate": 436.0 }, { "payer_name": "State Of Co Probation", "plan_name": "All Plans", "negotiated_rate": 578.86 }, { "payer_name": "Surest - United Health Care", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "Trans America Ins", "plan_name": "All Plans", "negotiated_rate": 220.0 }, { "payer_name": "Trustmark Small Business Benefits", "plan_name": "All Plans", "negotiated_rate": 436.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "All Plans", "negotiated_rate": 479.0 }, { "payer_name": "UMR/United Healthcare", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "United American Insurance CO", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "United Behavioral Health", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "United Behavioral Health Of California", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "United Health Care", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "United Health Care New Mexico", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "United Healthcare Student Resources", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "United Healthcare Supplement", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "United Select Health", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "United World Life", "plan_name": "All Plans", "negotiated_rate": 323.0 }, { "payer_name": "UPMC Health Plan", "plan_name": "All Plans", "negotiated_rate": 486.0 } ], "minimum": 220.0, "maximum": 750.0 } ] }, { "description": "Tri/Medi Gero PHP - 2 units", "code_information": [ { "code": "G0411", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 359.0, "discounted_cash_price": 359.0, "payer_specific_negotiated_charges": [ { "payer_name": "Allianz Global Assistance", "plan_name": "All Plans", "negotiated_rate": 135.13 }, { "payer_name": "Anthem BCBS Medicare Advantage", "plan_name": 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{ "payer_name": "Triwest Tricare", "plan_name": "All Plans", "negotiated_rate": 132.5 }, { "payer_name": "Triwest VA CCN Claims", "plan_name": "All Plans", "negotiated_rate": 58.61 } ], "minimum": 49.35, "maximum": 359.0 } ] }, { "description": "Gero Psych IOP 3 hrs", "code_information": [ { "code": "90853", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 600.0, "discounted_cash_price": 600.0, "payer_specific_negotiated_charges": [ { "payer_name": "Aetna", "plan_name": "All Plans", "negotiated_rate": 243.0 }, { "payer_name": "Aetna AMA Travel Insurance", "plan_name": "All Plans", "negotiated_rate": 243.0 }, { "payer_name": "Aetna Healthcare", "plan_name": "All Plans", "negotiated_rate": 243.0 }, { "payer_name": "Aetna Senior Supplemental Ins", "plan_name": "All Plans", "negotiated_rate": 243.0 }, { "payer_name": "Allsavers", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "American Republic Corp Ins", "plan_name": "All Plans", "negotiated_rate": 250.0 }, { "payer_name": "AMFirst", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "Anthem BCBS Medicare Advantage", "plan_name": "All Plans", "negotiated_rate": 226.84 }, { "payer_name": "Anthem BCBS Personal Choice", "plan_name": "All Plans", "negotiated_rate": 231.75 }, { "payer_name": "Anthem Blue Cross Blue Shield", "plan_name": "All Plans", "negotiated_rate": 231.75 }, { "payer_name": "Anthem Medi Blue Of Ohio", "plan_name": "All Plans", "negotiated_rate": 231.75 }, { "payer_name": "Anthem Medi-Blue", "plan_name": "All Plans", "negotiated_rate": 231.75 }, { "payer_name": "Anthem Mediblue Dual Advantage", "plan_name": "All Plans", "negotiated_rate": 231.75 }, { "payer_name": "ASR Health", "plan_name": "All Plans", "negotiated_rate": 231.0 }, { "payer_name": "Baylor Scott & White", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "BCBS HMO Colorado", "plan_name": "All Plans", "negotiated_rate": 218.0 }, { "payer_name": 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Plans", "negotiated_rate": 250.0 }, { "payer_name": "Denver Health DHHA", "plan_name": "All Plans", "negotiated_rate": 400.0 }, { "payer_name": "Denver Health Elevate Silver", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "Denver Health Med Plan Cofinity", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "Enterprise Group Planning, Inc", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "Federal Blue Cross", "plan_name": "All Plans", "negotiated_rate": 225.0 }, { "payer_name": "First Choice Health Network", "plan_name": "All Plans", "negotiated_rate": 449.0 }, { "payer_name": "Friday Health Plans", "plan_name": "All Plans", "negotiated_rate": 321.0 }, { "payer_name": "GEHA", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "GEHA-Untied Hlth Integrated Serv", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "HCA Optum", "plan_name": "All Plans", "negotiated_rate": 150.0 }, { 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Insurance", "plan_name": "All Plans", "negotiated_rate": 219.0 }, { "payer_name": "Mailhandlers", "plan_name": "All Plans", "negotiated_rate": 134.0 }, { "payer_name": "Mayo Health Solutions", "plan_name": "All Plans", "negotiated_rate": 250.0 }, { "payer_name": "Medica Elect", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "Medicaid United Healthcare", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "Medicare United HealthCare", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "Meritain Health- Aetna Choice POS", "plan_name": "All Plans", "negotiated_rate": 243.0 }, { "payer_name": "Mines And Associates, PC", "plan_name": "All Plans", "negotiated_rate": 450.0 }, { "payer_name": "Modern Assistance Program", "plan_name": "All Plans", "negotiated_rate": 600.0 }, { "payer_name": "Molina Healthcare Of Texas", "plan_name": "All Plans", "negotiated_rate": 350.0 }, { "payer_name": "Motivhealth", "plan_name": "All Plans", "negotiated_rate": 157.0 }, { "payer_name": "Mountain Health Co-op", "plan_name": "All Plans", "negotiated_rate": 231.75 }, { "payer_name": "New Mexico Medicaid", "plan_name": "All Plans", "negotiated_rate": 212.0 }, { "payer_name": "Northeast HP- RMHP", "plan_name": "All Plans", "negotiated_rate": 450.0 }, { "payer_name": "Optum Health Behavioral Solutions", "plan_name": "All Plans", "negotiated_rate": 133.0 }, { "payer_name": "Oxford Health - United Behavioral Health", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "Pacificare Behavioral Health", "plan_name": "All Plans", "negotiated_rate": 140.0 }, { "payer_name": "ParkCare Plus", "plan_name": "All Plans", "negotiated_rate": 400.0 }, { "payer_name": "Provider Network Of America", "plan_name": "All Plans", "negotiated_rate": 324.77 }, { "payer_name": "RMHP Medicare Optum", "plan_name": "All Plans", "negotiated_rate": 232.0 }, { "payer_name": "Routt County Jail & Detention Center", "plan_name": "All Plans", "negotiated_rate": 400.0 }, { "payer_name": "Secure Horizons Direct", "plan_name": "All Plans", "negotiated_rate": 140.0 }, { "payer_name": "Select Health Insurance", "plan_name": "All Plans", "negotiated_rate": 300.0 }, { "payer_name": "Select Health Medicare Adv", "plan_name": "All Plans", "negotiated_rate": 300.0 }, { "payer_name": "Selman And Company", "plan_name": "All Plans", "negotiated_rate": 140.0 }, { "payer_name": "Shelter Point", "plan_name": "All Plans", "negotiated_rate": 400.0 }, { "payer_name": "Simplan Insurance", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "Simplified Benefits Administrators", "plan_name": "All Plans", "negotiated_rate": 300.0 }, { "payer_name": "Starmark Insurance", "plan_name": "All Plans", "negotiated_rate": 243.0 }, { "payer_name": "State Of Co Probation", "plan_name": "All Plans", "negotiated_rate": 275.0 }, { "payer_name": "Surest - United Health Care", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "Trans America Ins", "plan_name": "All Plans", "negotiated_rate": 220.0 }, { "payer_name": "Trustmark Small Business Benefits", "plan_name": "All Plans", "negotiated_rate": 243.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "All Plans", "negotiated_rate": 257.0 }, { "payer_name": "UMR/United Healthcare", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "United American Insurance CO", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "United Behavioral Health", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "United Behavioral Health Of California", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "United Health Care", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "United Health Care New Mexico", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "United Healthcare Student Resources", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "United Healthcare Supplement", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "United Select Health", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "United World Life", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "UPMC Health Plan", "plan_name": "All Plans", "negotiated_rate": 261.0 } ], "minimum": 133.0, "maximum": 600.0 } ] }, { "description": "Tri/Medi Gero IOP - 2 unit", "code_information": [ { "code": "90853", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 229.0, "discounted_cash_price": 229.0, "payer_specific_negotiated_charges": [ { "payer_name": "Anthem BCBS Medicare Advantage", "plan_name": "All Plans", "negotiated_rate": 113.42 }, { "payer_name": "Carelon BH Kaiser", "plan_name": "All Plans", "negotiated_rate": 229.0 }, { "payer_name": "Clear Springs Health Inc", "plan_name": "All Plans", "negotiated_rate": 115.73 }, { "payer_name": "Humana Gold Choice", "plan_name": "All Plans", "negotiated_rate": 113.42 }, { "payer_name": "Medicare United HealthCare", "plan_name": "All Plans", "negotiated_rate": 100.63 }, { "payer_name": "Rocky Mountain Pace", "plan_name": "All Plans", "negotiated_rate": 100.43 }, { "payer_name": "Tricare West-United Healthcare", "plan_name": "All Plans", "negotiated_rate": 170.21 }, { "payer_name": "Triwest VA CCN Claims", "plan_name": "All Plans", "negotiated_rate": 104.2 } ], "minimum": 100.43, "maximum": 229.0 } ] }, { "description": "Tri/Medi Gero IOP - 3 unit", "code_information": [ { "code": "90853", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 229.0, "discounted_cash_price": 229.0, "payer_specific_negotiated_charges": [ { "payer_name": "Amerigroup", "plan_name": "All Plans", "negotiated_rate": 66.95 }, { "payer_name": "Anthem BCBS Medicare Advantage", "plan_name": "All Plans", "negotiated_rate": 75.62 }, { "payer_name": "Anthem Medi Blue Of Ohio", "plan_name": "All Plans", "negotiated_rate": 66.95 }, { "payer_name": "Carelon BH Kaiser", "plan_name": "All Plans", "negotiated_rate": 229.0 }, { "payer_name": "Clear Springs Health Inc", "plan_name": "All Plans", "negotiated_rate": 77.15 }, { "payer_name": "Humana Gold Choice", "plan_name": "All Plans", "negotiated_rate": 75.62 }, { "payer_name": "Medicare United HealthCare", "plan_name": "All Plans", "negotiated_rate": 67.09 }, { "payer_name": "Rocky Mountain Pace", "plan_name": "All Plans", "negotiated_rate": 54.0 }, { "payer_name": "Tricare West-United Healthcare", "plan_name": "All Plans", "negotiated_rate": 170.21 }, { "payer_name": "Triwest VA CCN Claims", "plan_name": "All Plans", "negotiated_rate": 69.47 } ], "minimum": 54.0, "maximum": 229.0 } ] }, { "description": "Tri Gero IOP 1 unit", "code_information": [ { "code": "S9480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 398.0, "discounted_cash_price": 398.0, "payer_specific_negotiated_charges": [ { "payer_name": "Allianz Global Assistance", "plan_name": "All Plans", "negotiated_rate": 208.39 }, { "payer_name": "HNFS Tricare West", "plan_name": "All Plans", "negotiated_rate": 398.0 }, { "payer_name": "Tricare West-United Healthcare", "plan_name": "All Plans", "negotiated_rate": 162.0 }, { "payer_name": "Triwest Tricare", "plan_name": "All Plans", "negotiated_rate": 398.0 } ], "minimum": 162.0, "maximum": 398.0 } ] }, { "description": "MCR IOP Adult - 2 units", "code_information": [ { "code": "90853", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 300.02, "discounted_cash_price": 300.02, "payer_specific_negotiated_charges": [ { "payer_name": "AARP Medicare Complete", "plan_name": "All Plans", "negotiated_rate": 167.34 }, { "payer_name": "Administrative District Council 1 Welfar", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "Aetna Healthcare", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "Allegiance Benefit Plan", "plan_name": "All Plans", "negotiated_rate": 167.34 }, { "payer_name": "Allianz Global Assistance", "plan_name": "All Plans", "negotiated_rate": 167.34 }, { "payer_name": "Ameriben", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "American Family Ins", "plan_name": "All Plans", "negotiated_rate": 167.34 }, { "payer_name": "American Republic Insurance", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "Anthem BCBS Medicare Advantage", "plan_name": "All Plans", "negotiated_rate": 113.42 }, { "payer_name": "Anthem BCBS Personal Choice", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "Anthem Blue Cross Blue Shield", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "Anthem Medi Blue Of Ohio", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "Anthem Medi-Blue", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "Anthem Mediblue Dual Advantage", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "APWU Health Plan", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "Assurant Health", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "Barrick Gold Corp", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "Behavioral Health Inc", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "Blue Card Nasco", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "Bridge Point", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "Care Source", "plan_name": "All Plans", "negotiated_rate": 167.34 }, { "payer_name": "ChampVA", "plan_name": "All Plans", "negotiated_rate": 167.34 }, { "payer_name": "Cigna", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "Cigna Behavioral Health", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "Cigna International", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "Cigna/GreatWest Healthcare", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "Cigna/Health Partners Inc", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "Clear Springs Health Inc", "plan_name": "All Plans", "negotiated_rate": 115.73 }, { "payer_name": "CNIC", "plan_name": "All Plans", "negotiated_rate": 250.0 }, { "payer_name": "Cofinity", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "Colorado Access", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "Colorado Access Advantage", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "Coventry Health Care", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "Cover Colorado Rocky Mountain Health", "plan_name": "All Plans", "negotiated_rate": 300.02 }, { "payer_name": "Denver Health Medical Plan", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "Deseret Healthcare Employee", "plan_name": "All Plans", "negotiated_rate": 167.34 }, { "payer_name": "EBMS", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "First Health", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "FMH Benefit Services", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "GEHA", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "GEHA-Untied Hlth Integrated Serv", "plan_name": "All Plans", "negotiated_rate": 130.0 }, { "payer_name": "Golden Rule/UHC", "plan_name": "All Plans", "negotiated_rate": 130.0 }, { "payer_name": "Group Benefits", "plan_name": "All Plans", "negotiated_rate": 167.34 }, { "payer_name": "HealthChoice", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "HealthScope Benefits Inc", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "Humana Gold Choice", "plan_name": "All Plans", "negotiated_rate": 113.42 }, { "payer_name": "Humana Healthcare", "plan_name": "All Plans", "negotiated_rate": 180.0 }, { "payer_name": "Kaiser Permanente Senior Advantage HMO", "plan_name": "All Plans", "negotiated_rate": 102.12 }, { "payer_name": "Maestro Health", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "Magellan Devoted Health Plans", "plan_name": "All Plans", "negotiated_rate": 109.5 }, { "payer_name": "Medicare United HealthCare", "plan_name": "All Plans", "negotiated_rate": 167.34 }, { "payer_name": "Rocky Mountain Pace", "plan_name": "All Plans", "negotiated_rate": 85.8 }, { "payer_name": "SECURE HORIZONS", "plan_name": "All Plans", "negotiated_rate": 89.4 }, { "payer_name": "Total Long Term Care", "plan_name": "All Plans", "negotiated_rate": 94.35 }, { "payer_name": "Total Longterm Care INC", "plan_name": "All Plans", "negotiated_rate": 94.35 }, { "payer_name": "Tricare Europe Region 13", "plan_name": "All Plans", "negotiated_rate": 94.35 }, { "payer_name": "Tricare 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300.02 } ] }, { "description": "IOP Adult Daily Rate", "code_information": [ { "code": "S9480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 710.7, "discounted_cash_price": 710.7, "payer_specific_negotiated_charges": [ { "payer_name": "AARP Medicare Complete", "plan_name": "All Plans", "negotiated_rate": 167.34 }, { "payer_name": "Administrative District Council 1 Welfar", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "Aetna", "plan_name": "All Plans", "negotiated_rate": 302.0 }, { "payer_name": "Aetna", "plan_name": "All Plans", "negotiated_rate": 311.0 }, { "payer_name": "Aetna", "plan_name": "All Plans", "negotiated_rate": 320.0 }, { "payer_name": "Aetna AMA Travel Insurance", "plan_name": "All Plans", "negotiated_rate": 302.0 }, { "payer_name": "Aetna AMA Travel Insurance", "plan_name": "All Plans", "negotiated_rate": 311.0 }, { "payer_name": "Aetna AMA Travel Insurance", "plan_name": "All Plans", "negotiated_rate": 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"payer_name": "ComPsych", "plan_name": "All Plans", "negotiated_rate": 250.0 }, { "payer_name": "Continental Insurance - Marpai Health", "plan_name": "All Plans", "negotiated_rate": 258.0 }, { "payer_name": "Coventry Health Care", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "Cover Colorado Rocky Mountain Health", "plan_name": "All Plans", "negotiated_rate": 300.02 }, { "payer_name": "Dean Health Plans", "plan_name": "All Plans", "negotiated_rate": 250.0 }, { "payer_name": "Denver Health DHHA", "plan_name": "All Plans", "negotiated_rate": 400.0 }, { "payer_name": "Denver Health Elevate Silver", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "Denver Health Med Plan Cofinity", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "Denver Health Medical Plan", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "Deseret Healthcare Employee", "plan_name": "All Plans", "negotiated_rate": 167.34 }, { "payer_name": "EBMS", "plan_name": "All Plans", "negotiated_rate": 250.0 }, { "payer_name": "Employers Health Network", "plan_name": "All Plans", "negotiated_rate": 302.0 }, { "payer_name": "Enterprise Group Planning, Inc", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "Equitable Life And Casualty Insurance Co", "plan_name": "All Plans", "negotiated_rate": 167.34 }, { "payer_name": "Equitable Plan Services", "plan_name": "All Plans", "negotiated_rate": 225.0 }, { "payer_name": "Evercare - Medicaid New Mexico", "plan_name": "All Plans", "negotiated_rate": 167.34 }, { "payer_name": "Federal Blue Cross", "plan_name": "All Plans", "negotiated_rate": 231.75 }, { "payer_name": "First Choice Health Network", "plan_name": "All Plans", "negotiated_rate": 250.0 }, { "payer_name": "First Health", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "FMH Benefit Services", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "Friday Health Plans", "plan_name": "All Plans", "negotiated_rate": 321.0 }, { "payer_name": "GEHA", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "GEHA-Untied Hlth Integrated Serv", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "Golden Rule/UHC", "plan_name": "All Plans", "negotiated_rate": 130.0 }, { "payer_name": "Gravie Admin Service Aetna", "plan_name": "All Plans", "negotiated_rate": 293.0 }, { "payer_name": "Group Benefits", "plan_name": "All Plans", "negotiated_rate": 167.34 }, { "payer_name": "HAP Aetna", "plan_name": "All Plans", "negotiated_rate": 302.0 }, { "payer_name": "HAP Aetna", "plan_name": "All Plans", "negotiated_rate": 311.0 }, { "payer_name": "HAP Aetna", "plan_name": "All Plans", "negotiated_rate": 320.0 }, { "payer_name": "Harvard Pilgrim HealthCare", "plan_name": "All Plans", "negotiated_rate": 167.34 }, { "payer_name": "HCA Optum", "plan_name": "All Plans", "negotiated_rate": 150.0 }, { "payer_name": "Health Alliance", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "Health Management Concepts", "plan_name": "All Plans", "negotiated_rate": 250.0 }, { "payer_name": "Health Net Commercial Claims", "plan_name": "All Plans", "negotiated_rate": 229.0 }, { "payer_name": "HealthChoice", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "HealthComp Integrated Solutions LLC", "plan_name": "All Plans", "negotiated_rate": 302.0 }, { "payer_name": "HealthComp Integrated Solutions LLC", "plan_name": "All Plans", "negotiated_rate": 311.0 }, { "payer_name": "HealthComp Integrated Solutions LLC", "plan_name": "All Plans", "negotiated_rate": 320.0 }, { "payer_name": "HealthScope Benefits Inc", "plan_name": "All Plans", "negotiated_rate": 258.0 }, { "payer_name": "Hemet Community Medical Group", "plan_name": "All Plans", "negotiated_rate": 130.0 }, { "payer_name": "Humana Gold Choice", "plan_name": "All Plans", "negotiated_rate": 166.34 }, { "payer_name": "Humana Healthcare", "plan_name": "All Plans", "negotiated_rate": 180.0 }, { "payer_name": "Huntsman Mental Health Institute - BHN", "plan_name": "All Plans", "negotiated_rate": 231.75 }, { "payer_name": "HWBS Claims", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "Imagine 360 Administrators", "plan_name": "All Plans", "negotiated_rate": 400.0 }, { "payer_name": "Kaiser Permanente", "plan_name": "All Plans", "negotiated_rate": 185.0 }, { "payer_name": "Kaiser Permanente Denver", "plan_name": "All Plans", "negotiated_rate": 185.0 }, { "payer_name": "Kaiser Permanente Northern", "plan_name": "All Plans", "negotiated_rate": 185.0 }, { "payer_name": "Kaiser Permanente Senior Advantage HMO", "plan_name": "All Plans", "negotiated_rate": 188.69 }, { "payer_name": "Liberty Healthshare", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "Life Shield STM - Ins TPA", "plan_name": "All Plans", "negotiated_rate": 250.0 }, { "payer_name": "LINECO Mental Health & Substance 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"Wyoming Pace", "plan_name": "All Plans", "negotiated_rate": 178.8 } ], "minimum": 90.56, "maximum": 710.7 } ] }, { "description": "IOP Child/Adol", "code_information": [ { "code": "S9480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 618.0, "discounted_cash_price": 618.0, "payer_specific_negotiated_charges": [ { "payer_name": "Aetna", "plan_name": "All Plans", "negotiated_rate": 302.0 }, { "payer_name": "Aetna", "plan_name": "All Plans", "negotiated_rate": 311.0 }, { "payer_name": "Aetna", "plan_name": "All Plans", "negotiated_rate": 320.0 }, { "payer_name": "Aetna AMA Travel Insurance", "plan_name": "All Plans", "negotiated_rate": 302.0 }, { "payer_name": "Aetna AMA Travel Insurance", "plan_name": "All Plans", "negotiated_rate": 311.0 }, { "payer_name": "Aetna AMA Travel Insurance", "plan_name": "All Plans", "negotiated_rate": 320.0 }, { "payer_name": "Aetna Healthcare", "plan_name": "All Plans", "negotiated_rate": 302.0 }, { "payer_name": 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Health", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "Magellan Devoted Health Plans", "plan_name": "All Plans", "negotiated_rate": 219.0 }, { "payer_name": "Magellan Health Services", "plan_name": "All Plans", "negotiated_rate": 219.0 }, { "payer_name": "Magellan Insurance", "plan_name": "All Plans", "negotiated_rate": 219.0 }, { "payer_name": "Mailhandlers", "plan_name": "All Plans", "negotiated_rate": 130.0 }, { "payer_name": "Managed Care Insurance - MBR Claims", "plan_name": "All Plans", "negotiated_rate": 250.0 }, { "payer_name": "Managed Health Network Group", "plan_name": "All Plans", "negotiated_rate": 250.0 }, { "payer_name": "Mayo Health Solutions", "plan_name": "All Plans", "negotiated_rate": 250.0 }, { "payer_name": "Medica Elect", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "Medicaid United Healthcare", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "Medicare United HealthCare", "plan_name": "All 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"plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "UPMC Health Plan", "plan_name": "All Plans", "negotiated_rate": 261.0 }, { "payer_name": "Wellfleet", "plan_name": "All Plans", "negotiated_rate": 250.0 } ], "minimum": 48.14, "maximum": 618.0 } ] }, { "description": "Tri Adol IOP - 1 unit", "code_information": [ { "code": "90853", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 398.0, "discounted_cash_price": 398.0, "payer_specific_negotiated_charges": [ { "payer_name": "Allianz Global Assistance", "plan_name": "All Plans", "negotiated_rate": 208.39 }, { "payer_name": "HNFS Tricare West", "plan_name": "All Plans", "negotiated_rate": 398.0 }, { "payer_name": "Tricare West-United Healthcare", "plan_name": "All Plans", "negotiated_rate": 162.0 }, { "payer_name": "Triwest Tricare", "plan_name": "All Plans", "negotiated_rate": 398.0 } ], "minimum": 162.0, "maximum": 398.0 } ] }, { "description": "Tri Adol IOP - 2 unit", "code_information": [ { "code": "90853", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 199.0, "discounted_cash_price": 199.0, "payer_specific_negotiated_charges": [ { "payer_name": "Tricare West-United Healthcare", "plan_name": "All Plans", "negotiated_rate": 85.36 }, { "payer_name": "Triwest Tricare", "plan_name": "All Plans", "negotiated_rate": 199.0 } ], "minimum": 85.36, "maximum": 199.0 } ] }, { "description": "Tri Adol IOP - 3 unit", "code_information": [ { "code": "90853", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 132.67, "discounted_cash_price": 132.67, "payer_specific_negotiated_charges": [ { "payer_name": "Tricare West-United Healthcare", "plan_name": "All Plans", "negotiated_rate": 56.91 }, { "payer_name": "Triwest Tricare", "plan_name": "All Plans", "negotiated_rate": 132.67 } ], "minimum": 56.91, "maximum": 132.67 } ] }, { "description": "Tri Adult IOP - 1 unit", "code_information": [ { "code": "90853", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 398.0, "discounted_cash_price": 398.0, "payer_specific_negotiated_charges": [ { "payer_name": "Allianz Global Assistance", "plan_name": "All Plans", "negotiated_rate": 208.39 }, { "payer_name": "HNFS Tricare West", "plan_name": "All Plans", "negotiated_rate": 398.0 }, { "payer_name": "Tricare West-United Healthcare", "plan_name": "All Plans", "negotiated_rate": 162.0 }, { "payer_name": "Triwest VA CCN Claims", "plan_name": "All Plans", "negotiated_rate": 214.39 } ], "minimum": 162.0, "maximum": 398.0 } ] }, { "description": "Tri Adult IOP - 2 unit", "code_information": [ { "code": "90853", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 199.0, "discounted_cash_price": 199.0, "payer_specific_negotiated_charges": [ { "payer_name": "Tricare West-United Healthcare", "plan_name": "All Plans", "negotiated_rate": 85.36 }, { "payer_name": "Triwest Tricare", "plan_name": "All Plans", "negotiated_rate": 199.0 } ], "minimum": 85.36, "maximum": 199.0 } ] }, { "description": "Tri Adult IOP - 3 unit", "code_information": [ { "code": "90853", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 132.67, "discounted_cash_price": 132.67, "payer_specific_negotiated_charges": [ { "payer_name": "Tricare West-United Healthcare", "plan_name": "All Plans", "negotiated_rate": 56.91 }, { "payer_name": "Triwest Tricare", "plan_name": "All Plans", "negotiated_rate": 132.67 } ], "minimum": 56.91, "maximum": 132.67 } ] }, { "description": "IOP CD GERO", "code_information": [ { "code": "H0015", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 450.0, "discounted_cash_price": 450.0, "payer_specific_negotiated_charges": [ { "payer_name": "Aetna", "plan_name": "All Plans", "negotiated_rate": 302.0 }, { "payer_name": "Aetna", "plan_name": "All Plans", "negotiated_rate": 311.0 }, { "payer_name": 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231.75 }, { "payer_name": "Anthem Mediblue Dual Advantage", "plan_name": "All Plans", "negotiated_rate": 231.75 }, { "payer_name": "Baylor Scott & White", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "Bright Health Management", "plan_name": "All Plans", "negotiated_rate": 424.0 }, { "payer_name": "Carelon Behavioral Health", "plan_name": "All Plans", "negotiated_rate": 267.8 }, { "payer_name": "Carelon Behavioral Health", "plan_name": "All Plans", "negotiated_rate": 229.0 }, { "payer_name": "Carelon Behavioral Health Strategies", "plan_name": "All Plans", "negotiated_rate": 267.8 }, { "payer_name": "Carelon BH APWU", "plan_name": "All Plans", "negotiated_rate": 229.0 }, { "payer_name": "Carelon BH APWU", "plan_name": "All Plans", "negotiated_rate": 267.8 }, { "payer_name": "Carelon BH Employee Asst", "plan_name": "All Plans", "negotiated_rate": 229.0 }, { "payer_name": "Carelon BH Employee Asst", "plan_name": "All Plans", "negotiated_rate": 267.8 }, { 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Advantage", "plan_name": "All Plans", "negotiated_rate": 350.0 }, { "payer_name": "Colorado Access CHP+", "plan_name": "All Plans", "negotiated_rate": 367.5 }, { "payer_name": "ComPsych", "plan_name": "All Plans", "negotiated_rate": 289.0 }, { "payer_name": "Continental Insurance - Marpai Health", "plan_name": "All Plans", "negotiated_rate": 258.0 }, { "payer_name": "Denver Health DHHA", "plan_name": "All Plans", "negotiated_rate": 400.0 }, { "payer_name": "Denver Health Elevate Silver", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "Denver Health Med Plan Cofinity", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "Employers Health Network", "plan_name": "All Plans", "negotiated_rate": 302.0 }, { "payer_name": "Enterprise Group Planning, Inc", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "Federal Blue Cross", "plan_name": "All Plans", "negotiated_rate": 231.75 }, { "payer_name": "First Choice Health Network", "plan_name": "All Plans", "negotiated_rate": 250.0 }, { "payer_name": "Friday Health Plans", "plan_name": "All Plans", "negotiated_rate": 321.0 }, { "payer_name": "GEHA", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "GEHA-Untied Hlth Integrated Serv", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "Gravie Admin Service Aetna", "plan_name": "All Plans", "negotiated_rate": 293.0 }, { "payer_name": "HAP Aetna", "plan_name": "All Plans", "negotiated_rate": 302.0 }, { "payer_name": "HAP Aetna", "plan_name": "All Plans", "negotiated_rate": 311.0 }, { "payer_name": "HAP Aetna", "plan_name": "All Plans", "negotiated_rate": 320.0 }, { "payer_name": "HCA Optum", "plan_name": "All Plans", "negotiated_rate": 150.0 }, { "payer_name": "Health Alliance", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "HealthComp Integrated Solutions LLC", "plan_name": "All Plans", "negotiated_rate": 302.0 }, { "payer_name": "HealthComp Integrated Solutions LLC", "plan_name": "All Plans", "negotiated_rate": 311.0 }, { "payer_name": "HealthComp Integrated Solutions LLC", "plan_name": "All Plans", "negotiated_rate": 320.0 }, { "payer_name": "Humana Gold Choice", "plan_name": "All Plans", "negotiated_rate": 226.84 }, { "payer_name": "Humana Healthcare", "plan_name": "All Plans", "negotiated_rate": 300.0 }, { "payer_name": "Huntsman Mental Health Institute - BHN", "plan_name": "All Plans", "negotiated_rate": 231.75 }, { "payer_name": "Imagine 360 Administrators", "plan_name": "All Plans", "negotiated_rate": 400.0 }, { "payer_name": "Liberty Healthshare", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "Lucent Health", "plan_name": "All Plans", "negotiated_rate": 250.0 }, { "payer_name": "Maestro Health", "plan_name": "All Plans", "negotiated_rate": 200.0 }, { "payer_name": "Magellan Devoted Health Plans", "plan_name": "All Plans", "negotiated_rate": 219.0 }, { "payer_name": "Magellan Health Services", "plan_name": "All Plans", "negotiated_rate": 219.0 }, { "payer_name": "Magellan Insurance", "plan_name": "All Plans", "negotiated_rate": 219.0 }, { "payer_name": "Medica Elect", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "Medicaid United Healthcare", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "Medicare United HealthCare", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "Meritain Health", "plan_name": "All Plans", "negotiated_rate": 284.55 }, { "payer_name": "Meritain Health- Aetna Choice POS", "plan_name": "All Plans", "negotiated_rate": 302.0 }, { "payer_name": "Meritain Health- Aetna Choice POS", "plan_name": "All Plans", "negotiated_rate": 311.0 }, { "payer_name": "Meritain Health- Aetna Choice POS", "plan_name": "All Plans", "negotiated_rate": 320.0 }, { "payer_name": "Mines And Associates, PC", "plan_name": "All Plans", "negotiated_rate": 450.0 }, { "payer_name": "Motivhealth", "plan_name": "All Plans", "negotiated_rate": 157.0 }, { "payer_name": "Mountain Health Co-op", "plan_name": "All Plans", "negotiated_rate": 231.75 }, { "payer_name": "Multiplan", "plan_name": "All Plans", "negotiated_rate": 250.0 }, { "payer_name": "Northeast HP- RMHP", "plan_name": "All Plans", "negotiated_rate": 450.0 }, { "payer_name": "Oxford Health - United Behavioral Health", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "Redirect Health - Multiplan", "plan_name": "All Plans", "negotiated_rate": 250.0 }, { "payer_name": "RMHP HMO Optum", "plan_name": "All Plans", "negotiated_rate": 350.0 }, { "payer_name": "RMHP Medicare Optum", "plan_name": "All Plans", "negotiated_rate": 232.0 }, { "payer_name": "Rocky Mountain Pace", "plan_name": "All Plans", "negotiated_rate": 204.44 }, { "payer_name": "Rocky Mtn Pace", "plan_name": "All Plans", "negotiated_rate": 216.51 }, { "payer_name": "Routt County Jail & Detention Center", "plan_name": "All Plans", "negotiated_rate": 400.0 }, { "payer_name": "Sanford Health Ins - Multiplan", "plan_name": "All Plans", "negotiated_rate": 250.0 }, { "payer_name": "Select Health Insurance", "plan_name": "All Plans", "negotiated_rate": 300.0 }, { "payer_name": "Select Health Medicare Adv", "plan_name": "All Plans", "negotiated_rate": 300.0 }, { "payer_name": "Shelter Point", "plan_name": "All Plans", "negotiated_rate": 400.0 }, { "payer_name": "Simplified Benefits Administrators", "plan_name": "All Plans", "negotiated_rate": 300.0 }, { "payer_name": "State Of Co Probation", "plan_name": "All Plans", "negotiated_rate": 275.0 }, { "payer_name": "Surest - United Health Care", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "Triwest VA CCN Claims", "plan_name": "All Plans", "negotiated_rate": 231.45 }, { "payer_name": "Trustmark Small Business Benefits", "plan_name": "All Plans", "negotiated_rate": 250.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "All Plans", "negotiated_rate": 257.0 }, { "payer_name": "UMR/United Healthcare", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "United American Insurance CO", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "United Behavioral Health", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "United Behavioral Health Of California", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "United Health Care", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "United Health Care New Mexico", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "United Healthcare Student Resources", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "United Healthcare Supplement", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "United Select Health", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "United World Life", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "UPMC Health Plan", "plan_name": "All Plans", "negotiated_rate": 261.0 }, { "payer_name": "Wellfleet", "plan_name": "All Plans", "negotiated_rate": 250.0 } ], "minimum": 150.0, "maximum": 450.0 } ] }, { "description": "IOP CD ADULT", "code_information": [ { "code": "H0015", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 450.0, "discounted_cash_price": 450.0, "payer_specific_negotiated_charges": [ { "payer_name": "Aetna", "plan_name": "All Plans", "negotiated_rate": 302.0 }, { "payer_name": "Aetna", "plan_name": "All Plans", "negotiated_rate": 311.0 }, { "payer_name": "Aetna", "plan_name": "All Plans", "negotiated_rate": 320.0 }, { "payer_name": "Aetna AMA Travel Insurance", "plan_name": "All Plans", "negotiated_rate": 302.0 }, { "payer_name": "Aetna AMA Travel Insurance", "plan_name": "All Plans", "negotiated_rate": 311.0 }, { "payer_name": "Aetna AMA Travel Insurance", "plan_name": "All Plans", "negotiated_rate": 320.0 }, { "payer_name": "Aetna Healthcare", "plan_name": "All Plans", "negotiated_rate": 302.0 }, { "payer_name": "Aetna Healthcare", "plan_name": "All Plans", "negotiated_rate": 311.0 }, { "payer_name": "Aetna Healthcare", "plan_name": "All Plans", "negotiated_rate": 320.0 }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "All Plans", "negotiated_rate": 302.0 }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "All Plans", "negotiated_rate": 311.0 }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "All Plans", "negotiated_rate": 320.0 }, { "payer_name": "Aetna Senior Supplemental Ins", "plan_name": "All Plans", "negotiated_rate": 302.0 }, { "payer_name": "Aetna Senior Supplemental Ins", "plan_name": "All Plans", "negotiated_rate": 311.0 }, { "payer_name": "Aetna Senior Supplemental Ins", "plan_name": "All Plans", "negotiated_rate": 320.0 }, { "payer_name": "Allsavers", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "American Republic Corp Ins", "plan_name": "All Plans", "negotiated_rate": 250.0 }, { "payer_name": "AMFirst", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "Anthem BCBS Medicare Advantage", "plan_name": "All Plans", "negotiated_rate": 226.84 }, { "payer_name": "Anthem BCBS Personal Choice", "plan_name": "All Plans", "negotiated_rate": 231.75 }, { "payer_name": "Anthem Blue Cross Blue Shield", "plan_name": "All Plans", "negotiated_rate": 231.75 }, { "payer_name": "Anthem Medi Blue Of Ohio", "plan_name": "All Plans", "negotiated_rate": 231.75 }, { "payer_name": "Anthem Medi-Blue", "plan_name": "All Plans", "negotiated_rate": 231.75 }, { "payer_name": "Anthem Mediblue Dual Advantage", "plan_name": "All Plans", "negotiated_rate": 231.75 }, { "payer_name": "Baylor Scott & White", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "Bright Health Management", "plan_name": "All Plans", "negotiated_rate": 424.0 }, { "payer_name": "Carelon Behavioral Health", "plan_name": "All Plans", 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Behavioral Health", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "United Behavioral Health Of California", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "United Health Care", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "United Health Care New Mexico", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "United Healthcare Student Resources", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "United Healthcare Supplement", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "United Select Health", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "United World Life", "plan_name": "All Plans", "negotiated_rate": 165.0 }, { "payer_name": "UPMC Health Plan", "plan_name": "All Plans", "negotiated_rate": 261.0 }, { "payer_name": "Wellfleet", "plan_name": "All Plans", "negotiated_rate": 250.0 } ], "minimum": 150.0, "maximum": 450.0 } ] }, { 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"negotiated_rate": 165.0 }, { "payer_name": "Wellfleet", "plan_name": "All Plans", "negotiated_rate": 250.0 } ], "minimum": 150.0, "maximum": 450.0 } ] }, { "description": "TRI ADULT CD IOP", "code_information": [ { "code": "H0015", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 398.0, "discounted_cash_price": 398.0, "payer_specific_negotiated_charges": [ { "payer_name": "Aetna", "plan_name": "All Plans", "negotiated_rate": 302.0 }, { "payer_name": "Aetna", "plan_name": "All Plans", "negotiated_rate": 311.0 }, { "payer_name": "Aetna", "plan_name": "All Plans", "negotiated_rate": 320.0 }, { "payer_name": "Aetna AMA Travel Insurance", "plan_name": "All Plans", "negotiated_rate": 302.0 }, { "payer_name": "Aetna AMA Travel Insurance", "plan_name": "All Plans", "negotiated_rate": 311.0 }, { "payer_name": "Aetna AMA Travel Insurance", "plan_name": "All Plans", "negotiated_rate": 320.0 }, { "payer_name": "Aetna Healthcare", "plan_name": "All Plans", 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], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50.0, "discounted_cash_price": 50.0, "payer_specific_negotiated_charges": [ { "payer_name": "State Of Co Probation", "plan_name": "All Plans", "negotiated_rate": 50.0 } ], "minimum": 50.0, "maximum": 50.0 } ] }, { "description": "INDIVIDUAL PSYCHOTHERAPY", "code_information": [ { "code": "90837", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 156.0, "discounted_cash_price": 156.0, "payer_specific_negotiated_charges": [ { "payer_name": "Anthem BCBS Personal Choice", "plan_name": "All Plans", "negotiated_rate": 106.0 }, { "payer_name": "Anthem Blue Cross Blue Shield", "plan_name": "All Plans", "negotiated_rate": 106.0 }, { "payer_name": "Anthem Medi Blue Of Ohio", "plan_name": "All Plans", "negotiated_rate": 106.0 }, { "payer_name": "Anthem Medi-Blue", "plan_name": "All Plans", "negotiated_rate": 106.0 }, { "payer_name": "Anthem Mediblue Dual Advantage", "plan_name": "All Plans", "negotiated_rate": 106.0 }, { "payer_name": "Carelon Behavioral Health", "plan_name": "All Plans", "negotiated_rate": 55.0 }, { "payer_name": "Carelon Behavioral Health Strategies", "plan_name": "All Plans", "negotiated_rate": 55.0 }, { "payer_name": "Carelon BH APWU", "plan_name": "All Plans", "negotiated_rate": 55.0 }, { "payer_name": "Carelon BH Employee Asst", "plan_name": "All Plans", "negotiated_rate": 55.0 }, { "payer_name": "Carelon BH Great West", "plan_name": "All Plans", "negotiated_rate": 55.0 }, { "payer_name": "Carelon BH Kaiser", "plan_name": "All Plans", "negotiated_rate": 55.0 }, { "payer_name": "Carelon Health Colorado Medicaid", "plan_name": "All Plans", "negotiated_rate": 94.71 }, { "payer_name": "Carelon Medicare Advantage", "plan_name": "All Plans", "negotiated_rate": 55.0 }, { "payer_name": "Carelon Northeast Health Partners Mcaid", "plan_name": "All Plans", "negotiated_rate": 94.71 }, { "payer_name": "Colo Community Health Alliance", "plan_name": "All Plans", "negotiated_rate": 130.4 }, { "payer_name": "Colorado Access", "plan_name": "All Plans", "negotiated_rate": 130.0 }, { "payer_name": "Huntsman Mental Health Institute - BHN", "plan_name": "All Plans", "negotiated_rate": 106.0 }, { "payer_name": "Mountain Health Co-op", "plan_name": "All Plans", "negotiated_rate": 106.0 }, { "payer_name": "Northeast HP- RMHP", "plan_name": "All Plans", "negotiated_rate": 94.71 }, { "payer_name": "Select Health Insurance", "plan_name": "All Plans", "negotiated_rate": 156.0 }, { "payer_name": "Select Health Medicare Adv", "plan_name": "All Plans", "negotiated_rate": 156.0 }, { "payer_name": "State Of Co Probation", "plan_name": "All Plans", "negotiated_rate": 75.0 } ], "minimum": 55.0, "maximum": 156.0 } ] }, { "description": "Psych Tx Group", "code_information": [ { "code": "90853", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 85.0, "discounted_cash_price": 85.0, "payer_specific_negotiated_charges": [ { 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Of Co Probation", "plan_name": "All Plans", "negotiated_rate": 44.0 } ], "minimum": 23.46, "maximum": 85.0 } ] }, { "description": "SUBSEQ HOSP (15 MIN)", "code_information": [ { "code": "99231", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130.17, "discounted_cash_price": 130.17, "payer_specific_negotiated_charges": [ { "payer_name": "AARP Medicare Complete", "plan_name": "All Plans", "negotiated_rate": 32.26 }, { "payer_name": "Administrative District Council 1 Welfar", "plan_name": "All Plans", "negotiated_rate": 130.17 }, { "payer_name": "Aetna", "plan_name": "All Plans", "negotiated_rate": 32.26 }, { "payer_name": "Aetna AMA Travel Insurance", "plan_name": "All Plans", "negotiated_rate": 32.26 }, { "payer_name": "Aetna Healthcare", "plan_name": "All Plans", "negotiated_rate": 32.26 }, { "payer_name": "Aetna Senior Supplemental Ins", "plan_name": "All Plans", "negotiated_rate": 32.26 }, { "payer_name": "Allegiance Benefit Plan", "plan_name": 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1184.5 }, { "payer_name": "RMHP Medicare Optum", "plan_name": "All Plans", "negotiated_rate": 477.0 }, { "payer_name": "RMSCO, Inc", "plan_name": "All Plans", "negotiated_rate": 600.0 }, { "payer_name": "Rocky Mountain Health Plans Medicaid", "plan_name": "All Plans", "negotiated_rate": 1035.0 }, { "payer_name": "Rocky Mountain Pace", "plan_name": "All Plans", "negotiated_rate": 435.0 }, { "payer_name": "Rocky Mountain-Life Strategies", "plan_name": "All Plans", "negotiated_rate": 809.0 }, { "payer_name": "Routt County Jail & Detention Center", "plan_name": "All Plans", "negotiated_rate": 700.0 }, { "payer_name": "Safeco Ins Of America", "plan_name": "All Plans", "negotiated_rate": 600.0 }, { "payer_name": "Scan Healthcare Of Arizona", "plan_name": "All Plans", "negotiated_rate": 600.0 }, { "payer_name": "SECURE HORIZONS", "plan_name": "All Plans", "negotiated_rate": 800.0 }, { "payer_name": "Secure Horizons (Medicare)", "plan_name": "All Plans", "negotiated_rate": 800.0 }, { 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402.89 }, { "payer_name": "Triwest Tricare", "plan_name": "All Plans", "negotiated_rate": 502.33 }, { "payer_name": "Triwest VA CCN Claims", "plan_name": "All Plans", "negotiated_rate": 477.01 }, { "payer_name": "Trustmark Small Business Benefits", "plan_name": "All Plans", "negotiated_rate": 834.0 }, { "payer_name": "Tufts Health Plan", "plan_name": "All Plans", "negotiated_rate": 855.0 }, { "payer_name": "UMR", "plan_name": "All Plans", "negotiated_rate": 816.0 }, { "payer_name": "UMR/CEBT-PM085516", "plan_name": "All Plans", "negotiated_rate": 816.0 }, { "payer_name": "UMR/United Healthcare", "plan_name": "All Plans", "negotiated_rate": 1001.0 }, { "payer_name": "United American Insurance CO", "plan_name": "All Plans", "negotiated_rate": 1001.0 }, { "payer_name": "United Behavioral Health", "plan_name": "All Plans", "negotiated_rate": 1001.0 }, { "payer_name": "United Behavioral Health Of California", "plan_name": "All Plans", "negotiated_rate": 1001.0 }, { "payer_name": "United Health Care", "plan_name": "All Plans", "negotiated_rate": 1001.0 }, { "payer_name": "United Health Care New Mexico", "plan_name": "All Plans", "negotiated_rate": 1001.0 }, { "payer_name": "United Healthcare Student Resources", "plan_name": "All Plans", "negotiated_rate": 1001.0 }, { "payer_name": "United Healthcare Supplement", "plan_name": "All Plans", "negotiated_rate": 1001.0 }, { "payer_name": "United Select Health", "plan_name": "All Plans", "negotiated_rate": 1001.0 }, { "payer_name": "United World Life", "plan_name": "All Plans", "negotiated_rate": 1001.0 }, { "payer_name": "UPMC Health Plan", "plan_name": "All Plans", "negotiated_rate": 868.0 }, { "payer_name": "USAA Life Ins", "plan_name": "All Plans", "negotiated_rate": 600.0 }, { "payer_name": "WEBB TPA", "plan_name": "All Plans", "negotiated_rate": 600.0 }, { "payer_name": "Wellfleet", "plan_name": "All Plans", "negotiated_rate": 800.0 }, { "payer_name": "Winhealth", "plan_name": "All Plans", "negotiated_rate": 600.0 }, { 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}, { "payer_name": "Anthem BCBS Medicare Advantage", "plan_name": "All Plans", "negotiated_rate": 108.36 }, { "payer_name": "Anthem BCBS Personal Choice", "plan_name": "All Plans", "negotiated_rate": 150.0 }, { "payer_name": "Anthem Blue Cross Blue Shield", "plan_name": "All Plans", "negotiated_rate": 150.0 }, { "payer_name": "Anthem Medi Blue Of Ohio", "plan_name": "All Plans", "negotiated_rate": 150.0 }, { "payer_name": "Anthem Medi-Blue", "plan_name": "All Plans", "negotiated_rate": 150.0 }, { "payer_name": "Anthem Mediblue Dual Advantage", "plan_name": "All Plans", "negotiated_rate": 150.0 }, { "payer_name": "Baylor Scott & White", "plan_name": "All Plans", "negotiated_rate": 300.0 }, { "payer_name": "Bright Health Management", "plan_name": "All Plans", "negotiated_rate": 150.0 }, { "payer_name": "Carelon Health Colorado Medicaid", "plan_name": "All Plans", "negotiated_rate": 87.88 }, { "payer_name": "Cigna Behavioral Health", "plan_name": "All Plans", "negotiated_rate": 108.36 }, { "payer_name": "Cigna Health Spring Medicare Advantage", "plan_name": "All Plans", "negotiated_rate": 300.0 }, { "payer_name": "Cigna Zenith Administrators", "plan_name": "All Plans", "negotiated_rate": 87.88 }, { "payer_name": "Cigna/GreatWest Healthcare", "plan_name": "All Plans", "negotiated_rate": 150.0 }, { "payer_name": "Colo Community Health Alliance", "plan_name": "All Plans", "negotiated_rate": 87.88 }, { "payer_name": "Colorado Access", "plan_name": "All Plans", "negotiated_rate": 87.88 }, { "payer_name": "Colorado Access CHP+", "plan_name": "All Plans", "negotiated_rate": 87.88 }, { "payer_name": "Denver Health Elevate Silver", "plan_name": "All Plans", "negotiated_rate": 300.0 }, { "payer_name": "Denver Health Med Plan Cofinity", "plan_name": "All Plans", "negotiated_rate": 300.0 }, { "payer_name": "Enterprise Group Planning, Inc", "plan_name": "All Plans", "negotiated_rate": 300.0 }, { "payer_name": "Federal Blue Cross", "plan_name": "All Plans", "negotiated_rate": 300.0 }, { "payer_name": "GEHA", "plan_name": "All Plans", "negotiated_rate": 300.0 }, { "payer_name": "GEHA-Untied Hlth Integrated Serv", "plan_name": "All Plans", "negotiated_rate": 300.0 }, { "payer_name": "Health Alliance", "plan_name": "All Plans", "negotiated_rate": 300.0 }, { "payer_name": "HNFS Tricare West", "plan_name": "All Plans", "negotiated_rate": 300.0 }, { "payer_name": "Humana Gold Choice", "plan_name": "All Plans", "negotiated_rate": 108.36 }, { "payer_name": "Huntsman Mental Health Institute - BHN", "plan_name": "All Plans", "negotiated_rate": 150.0 }, { "payer_name": "Liberty Healthshare", "plan_name": "All Plans", "negotiated_rate": 300.0 }, { "payer_name": "Medica Elect", "plan_name": "All Plans", "negotiated_rate": 300.0 }, { "payer_name": "Medicaid United Healthcare", "plan_name": "All Plans", "negotiated_rate": 300.0 }, { "payer_name": "Medicare United HealthCare", "plan_name": "All Plans", "negotiated_rate": 108.36 }, { "payer_name": "Motivhealth", "plan_name": "All 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"negotiated_rate": 300.0 }, { "payer_name": "United Behavioral Health", "plan_name": "All Plans", "negotiated_rate": 300.0 }, { "payer_name": "United Behavioral Health Of California", "plan_name": "All Plans", "negotiated_rate": 300.0 }, { "payer_name": "United Health Care", "plan_name": "All Plans", "negotiated_rate": 300.0 }, { "payer_name": "United Health Care New Mexico", "plan_name": "All Plans", "negotiated_rate": 300.0 }, { "payer_name": "United Healthcare Student Resources", "plan_name": "All Plans", "negotiated_rate": 300.0 }, { "payer_name": "United Healthcare Supplement", "plan_name": "All Plans", "negotiated_rate": 300.0 }, { "payer_name": "United Select Health", "plan_name": "All Plans", "negotiated_rate": 300.0 }, { "payer_name": "United World Life", "plan_name": "All Plans", "negotiated_rate": 300.0 } ], "minimum": 87.88, "maximum": 400.0 } ] } ] }