Hospital

Analysis Date: 2025-08-28 17:30:51

In this analysis, we pull 5 samples from Hospital MRF data for 11 providers where multiple rates are posted for a J-code.

In general, the median() vs max() logic difference does not make a difference in rate selection. See here for a deeper dive into the infrequent cases where this logic difference leads to larger differences in selected rates.

Key Logic Difference:

• Clear Rates selects the max() within each contract methodology then selects the best rate. Uses plan bridge mapping to identify PPO vs HMO.
• DPR prioritizes according to plan product tiers, then selects the rate that is closest to the median.

Takeaways:

Provider ID: 1298

Sample 1/55

Payer: 7 | Provider: St Lukes Quakertown Campus | Code: J2185

Results:

• Number of rate records: 2
• Unique negotiated rates: 2
• ASP Payment Limit: $0.44
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $6.21
• Max negotiated_dollar by contract_methodology:
  • percent of total billed charges: $7.37
• Median dosage_std_dollar by payer_product_network:
  • Unsorted: $369.00
• Max dosage_std_dollar by contract_methodology:
  • percent of total billed charges: $737.00

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
43d26240bcf742259a35d862ea5f5a80	$5.06	$1.00	percent of total billed charges	Facility	Outpatient	$0.44	636		COMMERCIAL	500	milligram	100	MG
cd07661bd44c4115bfce5905f333cd27	$7.37	$737.00	percent of total billed charges	Facility	Outpatient	$0.44	636		COMMERCIAL	1	gram	100	MG

---

Sample 2/55

Payer: 567 | Provider: St Lukes Quakertown Campus | Code: J2795

Results:

• Number of rate records: 5
• Unique negotiated rates: 2
• ASP Payment Limit: $0.06
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $0.39
• Max negotiated_dollar by contract_methodology:
  • percent of total billed charges: $0.40
• Median dosage_std_dollar by payer_product_network:
  • Unsorted: $0.08
• Max dosage_std_dollar by contract_methodology:
  • percent of total billed charges: $0.20

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
d2ca9effc8c147978ca6ed4e0a64b5a7	$0.39	$0.20	percent of total billed charges	Facility	Outpatient	$0.06	636		COMMERCIAL	2	milligrams per milliliter	1	MG
c7437757b8af4f3f9fa888e575480b30	$0.39	$0.04	percent of total billed charges	Facility	Outpatient	$0.06	636		COMMERCIAL	10	milligrams per milliliter	1	MG
d3c2550d3bcb427fb177c0ef0d10134d	$0.39	$0.08	percent of total billed charges	Facility	Outpatient	$0.06	636		COMMERCIAL	5	milligrams per milliliter	1	MG
6f6161f076ff44bda8969f354184e717	$0.40	$nan	percent of total billed charges	Facility	Outpatient	$0.06	636		COMMERCIAL	None	None	1	MG
8c79a65258a24a67a207bda747c0df08	$0.40	$nan	percent of total billed charges	Facility	Outpatient	$0.06	636		COMMERCIAL	None	None	1	MG

---

Sample 3/55

Payer: 111 | Provider: St Lukes Quakertown Campus | Code: J1327

Results:

• Number of rate records: 3
• Unique negotiated rates: 2
• ASP Payment Limit: $27.58
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $2.79
• Max negotiated_dollar by contract_methodology:
  • percent of total billed charges: $2.79
• Median dosage_std_dollar by payer_product_network:
  • Unsorted: $0.70
• Max dosage_std_dollar by contract_methodology:
  • percent of total billed charges: $0.70

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
45d3649427c94f5faa040288e6c50743	$0.80	$0.05	percent of total billed charges	Facility	Outpatient	$27.58	636		COMMERCIAL	75	milligram	5	MG
9101404e7f8142ecb7a614f3cf5cecd6	$2.79	$0.70	percent of total billed charges	Facility	Outpatient	$27.58	636		COMMERCIAL	20	milligram	5	MG
eb1504f8f62044c19460cc79dba13e49	$2.79	$0.70	percent of total billed charges	Facility	Outpatient	$27.58	636		COMMERCIAL	20	milligram	5	MG

---

Sample 4/55

Payer: 643 | Provider: St Lukes Quakertown Campus | Code: J1250

Results:

• Number of rate records: 2
• Unique negotiated rates: 2
• ASP Payment Limit: $7.98
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $0.35
• Max negotiated_dollar by contract_methodology:
  • percent of total billed charges: $0.36
• Median dosage_std_dollar by payer_product_network:
  • Unsorted: $8.75
• Max dosage_std_dollar by contract_methodology:
  • percent of total billed charges: $17.50

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
6bb3ad9292444bb4b4ad9ab22b330af4	$0.34	$17.50	percent of total billed charges	Facility	Outpatient	$7.98	636		COMMERCIAL	5	milligrams per milliliter	250	MG
d1878a1307464874b14b2474cfaf83c6	$0.36	$0.00	percent of total billed charges	Facility	Outpatient	$7.98	636		COMMERCIAL	250	milligram	250	MG

---

Sample 5/55

Payer: 567 | Provider: St Lukes Quakertown Campus | Code: J9227

Results:

• Number of rate records: 2
• Unique negotiated rates: 2
• ASP Payment Limit: $82.86
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $3786.69
• Max negotiated_dollar by contract_methodology:
  • percent of total billed charges: $6311.16
• Median dosage_std_dollar by payer_product_network:
  • Unsorted: $126.20
• Max dosage_std_dollar by contract_methodology:
  • percent of total billed charges: $126.20

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
462d2c7e799f4c03a775871e83ca83f2	$1262.23	$126.20	percent of total billed charges	Facility	Outpatient	$82.86	636		COMMERCIAL	100	milligram	10	MG
a37bb7c4ef7b46149fb3439f56e575b2	$6311.16	$126.20	percent of total billed charges	Facility	Outpatient	$82.86	636		COMMERCIAL	500	milligram	10	MG

---

Provider ID: 1338

Sample 6/55

Payer: 12 | Provider: Windber Medical Center | Code: J1568

Results:

• Number of rate records: 2
• Unique negotiated rates: 2
• ASP Payment Limit: $48.38
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $49.56
• Max negotiated_dollar by contract_methodology:
  • other: $55.36
• Median dosage_std_dollar by payer_product_network:
  • Unsorted: $2480.00
• Max dosage_std_dollar by contract_methodology:
  • other: $2770.00

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
f760c40c028842318f7ed4fe3426c91f	$43.76	$2190.00	other	Facility	Outpatient	$48.38	636		UPMC	10	gram	500	MG
f243112a4aee42a2bfe522586826796e	$55.36	$2770.00	other	Professional	Outpatient	$48.38	636		UPMC	10	gram	500	MG

---

Sample 7/55

Payer: 7 | Provider: Windber Medical Center | Code: J7050

Results:

• Number of rate records: 2
• Unique negotiated rates: 2
• ASP Payment Limit: $0.71
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $0.69
• Max negotiated_dollar by contract_methodology:
  • case rate: $0.67
  • other: $0.71
• Median dosage_std_dollar by payer_product_network:
  • Unsorted: $2.50
• Max dosage_std_dollar by contract_methodology:
  • case rate: $2.50
  • other: $2.50

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
69bf018b9a89477d9309ef5f705302a1	$0.67	$2.50	case rate	Facility	Outpatient	$0.71	636		AETNA	100	milliliter	250	CC
03ed4a04f7174556b8e225a6203f9758	$0.71	$2.50	other	Professional	Outpatient	$0.71	636		AETNA	100	milliliter	250	CC

---

Sample 8/55

Payer: 76 | Provider: Windber Medical Center | Code: J1568

Results:

• Number of rate records: 2
• Unique negotiated rates: 2
• ASP Payment Limit: $48.38
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $1963.99
• Max negotiated_dollar by contract_methodology:
  • other: $48.99
  • percent of total billed charges: $3879.00
• Median dosage_std_dollar by payer_product_network:
  • Unsorted: $98200.00
• Max dosage_std_dollar by contract_methodology:
  • other: $2450.00
  • percent of total billed charges: $193950.00

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
a247c0d563ac45f99a9efaf4b646d73f	$48.99	$2450.00	other	Professional	Outpatient	$48.38	636		CIGNA	10	gram	500	MG
2ee8988203a949bab55a241d2c865f43	$3879.00	$193950.00	percent of total billed charges	Facility	Outpatient	$48.38	636		CIGNA	10	gram	500	MG

---

Sample 9/55

Payer: 7 | Provider: Windber Medical Center | Code: J1568

Results:

• Number of rate records: 2
• Unique negotiated rates: 2
• ASP Payment Limit: $48.38
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $45.73
• Max negotiated_dollar by contract_methodology:
  • case rate: $47.74
  • other: $43.71
• Median dosage_std_dollar by payer_product_network:
  • Unsorted: $2285.00
• Max dosage_std_dollar by contract_methodology:
  • case rate: $2385.00
  • other: $2185.00

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
b04940098043422cb9f87f1ffa1e15f1	$43.71	$2185.00	other	Professional	Outpatient	$48.38	636		AETNA	10	gram	500	MG
02ca9dda4e934860a2c0fbcea0473f51	$47.74	$2385.00	case rate	Facility	Outpatient	$48.38	636		AETNA	10	gram	500	MG

---

Sample 10/55

Payer: 12 | Provider: Windber Medical Center | Code: J7512

Results:

• Number of rate records: 2
• Unique negotiated rates: 2
• ASP Payment Limit: $0.00
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $0.20
• Max negotiated_dollar by contract_methodology:
  • other: $0.38
• Median dosage_std_dollar by payer_product_network:
  • Unsorted: $0.01
• Max dosage_std_dollar by contract_methodology:
  • other: $0.02

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
d42b7fa32d9541f5a1717f87f0690a43	$0.01	$0.00	other	Professional	Outpatient	$0.00	636		UPMC	20	milligram	1	MG
ebdefebb25414f3bac0afad7c867ab58	$0.38	$0.02	other	Facility	Outpatient	$0.00	636		UPMC	20	milligram	1	MG

---

Provider ID: 388

Sample 11/55

Payer: 12 | Provider: Geisinger Shamokin Area Community Hospital | Code: J2540

Results:

• Number of rate records: 12
• Unique negotiated rates: 3
• ASP Payment Limit: $0.88
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $1.32
• Max negotiated_dollar by contract_methodology:
  • fee schedule: $2.30
• Median dosage_std_dollar by payer_product_network:
  • Unsorted: $0.00
• Max dosage_std_dollar by contract_methodology:
  • fee schedule: $0.00

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
aaa3935f37e44062bba2621cafd52f50	$0.77	$0.00	fee schedule	None	Outpatient	$0.88	636		PRISON HEALTH SERVICES	40000	unit	600000	UNITS
04431c1ed56d440d9b62cc88cbe14877	$0.77	$0.00	fee schedule	None	Outpatient	$0.88	636		PRISON HEALTH SERVICES	20000000	units	600000	UNITS
052ab7f727be456ba5605ec222bba6a2	$0.77	$nan	fee schedule	None	Outpatient	$0.88	636		PRISON HEALTH SERVICES	None	None	600000	UNITS
2d9d841ff5794ac9812bfe2bed7b6ac5	$0.77	$0.00	fee schedule	None	Outpatient	$0.88	636		PRISON HEALTH SERVICES	60000	unit	600000	UNITS
128957aec3ac40c582ac8763c315b64f	$1.32	$nan	fee schedule	None	Outpatient	$0.88	636		WIRE ROPE	None	None	600000	UNITS
56bd491446204d06bca03d4d49d31109	$1.32	$0.00	fee schedule	None	Outpatient	$0.88	636		WIRE ROPE	60000	unit	600000	UNITS
77c245afe11e4ed094cdc2382e361f10	$1.32	$0.00	fee schedule	None	Outpatient	$0.88	636		WIRE ROPE	40000	unit	600000	UNITS
f87682f82ee84a1295e00be63e822c5a	$1.32	$0.00	fee schedule	None	Outpatient	$0.88	636		WIRE ROPE	20000000	units	600000	UNITS
a37bfadbe8f94604af06991bd081291c	$2.30	$0.00	fee schedule	None	Outpatient	$0.88	636		SEVEN CORNERS	40000	unit	600000	UNITS
b27fbd056d544f9aafd6208da0b02d1b	$2.30	$0.00	fee schedule	None	Outpatient	$0.88	636		SEVEN CORNERS	20000000	units	600000	UNITS
e029cb33c7584409a15ce53bd11561c3	$2.30	$0.00	fee schedule	None	Outpatient	$0.88	636		SEVEN CORNERS	60000	unit	600000	UNITS
3ba3365d00ad4fab975d9909d7479696	$2.30	$nan	fee schedule	None	Outpatient	$0.88	636		SEVEN CORNERS	None	None	600000	UNITS

---

Sample 12/55

Payer: 111 | Provider: Geisinger Shamokin Area Community Hospital | Code: J9351

Results:

• Number of rate records: 6
• Unique negotiated rates: 2
• ASP Payment Limit: $1.34
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $3.81
• Max negotiated_dollar by contract_methodology:
  • fee schedule: $4.63
• Median dosage_std_dollar by payer_product_network:
  • Unsorted: $0.10
• Max dosage_std_dollar by contract_methodology:
  • fee schedule: $0.12

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
1d45f87ef95f4b518176919cc676d352	$3.00	$0.07	fee schedule	None	Outpatient	$1.34	636		GEISINGER HEALTH PLAN - EMPLOYEE	4	milligram	0.1	MG
7ba30e657b1a49c3a763de3dfd317978	$3.00	$0.07	fee schedule	None	Outpatient	$1.34	636		GEISINGER HEALTH PLAN - EMPLOYEE	4	milligram	0.1	MG
bd85572d0fc34830a331207a8cbbe999	$3.00	$0.07	fee schedule	None	Outpatient	$1.34	636		GEISINGER HEALTH PLAN - EMPLOYEE	4	milligram	0.1	MG
b9a040e31d1c4387be8379c441b7ceda	$4.63	$0.12	fee schedule	None	Outpatient	$1.34	636		GEISINGER HEALTH PLAN - COMMERCIAL	4	milligram	0.1	MG
39f75bc0bb424309913aeefe3481714d	$4.63	$0.12	fee schedule	None	Outpatient	$1.34	636		GEISINGER HEALTH PLAN - COMMERCIAL	4	milligram	0.1	MG
57bf251d4d354bc4bdcc2f937522a157	$4.63	$0.12	fee schedule	None	Outpatient	$1.34	636		GEISINGER HEALTH PLAN - COMMERCIAL	4	milligram	0.1	MG

---

Sample 13/55

Payer: 174 | Provider: Geisinger Shamokin Area Community Hospital | Code: J3358

Results:

• Number of rate records: 2
• Unique negotiated rates: 2
• ASP Payment Limit: $13.29
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $51.84
• Max negotiated_dollar by contract_methodology:
  • fee schedule: $60.95
• Median dosage_std_dollar by payer_product_network:
  • Unsorted: $0.40
• Max dosage_std_dollar by contract_methodology:
  • fee schedule: $0.47

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
5e20e91f941b4addb7b84f1aa20767a8	$42.74	$0.33	fee schedule	None	Outpatient	$13.29	636		HIGHMARK BC/BS - SPECIAL CARE	130	milligram	1	MG
997b37fcc15f41e1b6a912678c4877ab	$60.95	$0.47	fee schedule	None	Outpatient	$13.29	636		HIGHMARK BC/BS	130	milligram	1	MG

---

Sample 14/55

Payer: 12 | Provider: Geisinger Shamokin Area Community Hospital | Code: J0221

Results:

• Number of rate records: 3
• Unique negotiated rates: 3
• ASP Payment Limit: $206.62
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $342.66
• Max negotiated_dollar by contract_methodology:
  • fee schedule: $598.65
• Median dosage_std_dollar by payer_product_network:
  • Unsorted: $68.50
• Max dosage_std_dollar by contract_methodology:
  • fee schedule: $119.70

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
234f411106a248939d96e6c30177ee84	$201.57	$40.30	fee schedule	None	Outpatient	$206.62	636		PRISON HEALTH SERVICES	50	milligram	10	MG
3f9284d376c44a29bd6f012398076987	$342.66	$68.50	fee schedule	None	Outpatient	$206.62	636		WIRE ROPE	50	milligram	10	MG
73f3028ba33c4ca6a607ae0036ce7978	$598.65	$119.70	fee schedule	None	Outpatient	$206.62	636		SEVEN CORNERS	50	milligram	10	MG

---

Sample 15/55

Payer: 12 | Provider: Geisinger Shamokin Area Community Hospital | Code: J0640

Results:

• Number of rate records: 30
• Unique negotiated rates: 3
• ASP Payment Limit: $3.95
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $5.97
• Max negotiated_dollar by contract_methodology:
  • fee schedule: $10.43
• Median dosage_std_dollar by payer_product_network:
  • Unsorted: $5.00
• Max dosage_std_dollar by contract_methodology:
  • fee schedule: $52.00

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
c1af7c537b214d06a84599d94cdd3b48	$3.51	$17.50	fee schedule	None	Outpatient	$3.95	636		PRISON HEALTH SERVICES	10	milligrams per milliliter	50	MG
1ae80aaa7a4946628831e69e4680df31	$3.51	$1.00	fee schedule	None	Outpatient	$3.95	636		PRISON HEALTH SERVICES	200	milligram	50	MG
6660f3da402f47cdbef9af60a988eef6	$3.51	$17.50	fee schedule	None	Outpatient	$3.95	636		PRISON HEALTH SERVICES	10	milligrams per milliliter	50	MG
aafa9d29af874e0e8639c9fde887beb4	$3.51	$1.00	fee schedule	None	Outpatient	$3.95	636		PRISON HEALTH SERVICES	200	milligram	50	MG
5702d72789594fb5901263cce31cd627	$3.51	$17.50	fee schedule	None	Outpatient	$3.95	636		PRISON HEALTH SERVICES	10	milligrams per milliliter	50	MG
5596eb8d197b4e19bbed7037d35a69ce	$3.51	$9.00	fee schedule	None	Outpatient	$3.95	636		PRISON HEALTH SERVICES	20	milligrams per milliliter	50	MG
090a8470e941491c8571ded69c8e7159	$3.51	$0.50	fee schedule	None	Outpatient	$3.95	636		PRISON HEALTH SERVICES	350	milligram	50	MG
6c6b2e0dd5584283b1ebc5004ec05ce6	$3.51	$2.00	fee schedule	None	Outpatient	$3.95	636		PRISON HEALTH SERVICES	100	milligram	50	MG
896689f3bf1a4e2e8f2008c33f93af47	$3.51	$3.50	fee schedule	None	Outpatient	$3.95	636		PRISON HEALTH SERVICES	50	milligram	50	MG
fab230fc2529415882f5febc722a127d	$3.51	$2.00	fee schedule	None	Outpatient	$3.95	636		PRISON HEALTH SERVICES	100	milligram	50	MG
287a0e0fe4ff49ba84078e8c634207fa	$5.97	$6.00	fee schedule	None	Outpatient	$3.95	636		WIRE ROPE	50	milligram	50	MG
bf07f7ad408748dab87cf9e302ac5fb9	$5.97	$3.00	fee schedule	None	Outpatient	$3.95	636		WIRE ROPE	100	milligram	50	MG
9b998b3663e94f7f9655b4c35fdfaeb5	$5.97	$30.00	fee schedule	None	Outpatient	$3.95	636		WIRE ROPE	10	milligrams per milliliter	50	MG
611556e827a74dc5ab979ca65d7a8d6a	$5.97	$15.00	fee schedule	None	Outpatient	$3.95	636		WIRE ROPE	20	milligrams per milliliter	50	MG
e86d4169bec64ab5a9c7e787b68a091c	$5.97	$30.00	fee schedule	None	Outpatient	$3.95	636		WIRE ROPE	10	milligrams per milliliter	50	MG
a8f749633a644222bed116087b4e2f2d	$5.97	$3.00	fee schedule	None	Outpatient	$3.95	636		WIRE ROPE	100	milligram	50	MG
c81a1bc7cf0d40538c97dd76f268e716	$5.97	$30.00	fee schedule	None	Outpatient	$3.95	636		WIRE ROPE	10	milligrams per milliliter	50	MG
be829e80e74141aa8d7b1755c6cfe5a3	$5.97	$1.50	fee schedule	None	Outpatient	$3.95	636		WIRE ROPE	200	milligram	50	MG
74a3db72687e41cbbb1d9821e197408c	$5.97	$1.00	fee schedule	None	Outpatient	$3.95	636		WIRE ROPE	350	milligram	50	MG
e7beed9b9a4a468c90fb81c998e6b476	$5.97	$1.50	fee schedule	None	Outpatient	$3.95	636		WIRE ROPE	200	milligram	50	MG
af4551252f694e40ab03a48fe71955df	$10.43	$1.50	fee schedule	None	Outpatient	$3.95	636		SEVEN CORNERS	350	milligram	50	MG
b662ffac586c41e39c5d9a5d90b790de	$10.43	$5.00	fee schedule	None	Outpatient	$3.95	636		SEVEN CORNERS	100	milligram	50	MG
e9c4474dbb404154b65934f628642760	$10.43	$52.00	fee schedule	None	Outpatient	$3.95	636		SEVEN CORNERS	10	milligrams per milliliter	50	MG
a70c7c86bb5e4c66914fcad1f5c6b9a0	$10.43	$2.50	fee schedule	None	Outpatient	$3.95	636		SEVEN CORNERS	200	milligram	50	MG
71cbe8fc8dc943ab89b4bc7ddc373e8f	$10.43	$52.00	fee schedule	None	Outpatient	$3.95	636		SEVEN CORNERS	10	milligrams per milliliter	50	MG
f9e777afd19f47e999f2da7789639ae1	$10.43	$26.00	fee schedule	None	Outpatient	$3.95	636		SEVEN CORNERS	20	milligrams per milliliter	50	MG
443f3015389b4c7aae40a2b9a8e8543c	$10.43	$52.00	fee schedule	None	Outpatient	$3.95	636		SEVEN CORNERS	10	milligrams per milliliter	50	MG
b19cbdd33ee14c4d97dfc188378e0c08	$10.43	$5.00	fee schedule	None	Outpatient	$3.95	636		SEVEN CORNERS	100	milligram	50	MG
1e602d48c30946c5be36d7e8795dd447	$10.43	$10.50	fee schedule	None	Outpatient	$3.95	636		SEVEN CORNERS	50	milligram	50	MG
7e3475f644f4453db0d7f451d40e7fbb	$10.43	$2.50	fee schedule	None	Outpatient	$3.95	636		SEVEN CORNERS	200	milligram	50	MG

---

Provider ID: 1304

Sample 16/55

Payer: 1107 | Provider: Robert Packer Hospital | Code: J9181

Results:

• Number of rate records: 2
• Unique negotiated rates: 2
• ASP Payment Limit: $1.30
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $31.95
• Max negotiated_dollar by contract_methodology:
  • fee schedule: $53.25
• Median dosage_std_dollar by payer_product_network:
  • Unsorted: $1.10
• Max dosage_std_dollar by contract_methodology:
  • fee schedule: $1.10

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
e530f52a12d1424bad56e8eb8b9941c5	$10.65	$1.10	fee schedule	Facility	Outpatient	$1.30	636		No plan	100	milligram	10	MG
49ec9bcb9ff040ccb42337453d213b00	$53.25	$1.10	fee schedule	Facility	Outpatient	$1.30	636		No plan	500	milligram	10	MG

---

Sample 17/55

Payer: 774 | Provider: Robert Packer Hospital | Code: J9305

Results:

• Number of rate records: 4
• Unique negotiated rates: 2
• ASP Payment Limit: $3.73
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $168.45
• Max negotiated_dollar by contract_methodology:
  • fee schedule: $280.75
  • percent of total billed charges: $56.15
• Median dosage_std_dollar by payer_product_network:
  • Unsorted: $5.60
• Max dosage_std_dollar by contract_methodology:
  • fee schedule: $5.60
  • percent of total billed charges: $5.60

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
ebb0cb2b08084b7bba9ccfa3d3dcf503	$56.15	$5.60	percent of total billed charges	Facility	Outpatient	$3.73	636		No plan	100	milligram	10	MG
b39406c12105492dad7dc6ab95ce0a0b	$56.15	$5.60	percent of total billed charges	Facility	Outpatient	$3.73	636		No plan	100	milligram	10	MG
cb5ae2104bb946d48ea1ef471f7d6720	$280.75	$5.60	fee schedule	Facility	Outpatient	$3.73	636		No plan	500	milligram	10	MG
fe82e6ec59e94dd3b4f55e7af2c9b869	$280.75	$5.60	fee schedule	Facility	Outpatient	$3.73	636		No plan	500	milligram	10	MG

---

Sample 18/55

Payer: 1107 | Provider: Robert Packer Hospital | Code: J9308

Results:

• Number of rate records: 2
• Unique negotiated rates: 2
• ASP Payment Limit: $74.45
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $6260.40
• Max negotiated_dollar by contract_methodology:
  • fee schedule: $10434.00
• Median dosage_std_dollar by payer_product_network:
  • Unsorted: $104.35
• Max dosage_std_dollar by contract_methodology:
  • fee schedule: $104.35

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
607fc9d36fc2421981cfebacba6de40d	$2086.80	$104.35	fee schedule	Facility	Outpatient	$74.45	636		No plan	100	milligram	5	MG
e56fb89a990844b6933c81efb3015779	$10434.00	$104.35	fee schedule	Facility	Outpatient	$74.45	636		No plan	500	milligram	5	MG

---

Sample 19/55

Payer: 274 | Provider: Robert Packer Hospital | Code: J3475

Results:

• Number of rate records: 7
• Unique negotiated rates: 3
• ASP Payment Limit: $0.50
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $2.82
• Max negotiated_dollar by contract_methodology:
  • fee schedule: $11.28
• Median dosage_std_dollar by payer_product_network:
  • Unsorted: $1410.00
• Max dosage_std_dollar by contract_methodology:
  • fee schedule: $1410.00

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
9d171626fbfb4d15acc9750ad16abbc8	$2.82	$nan	fee schedule	Facility	Outpatient	$0.50	636		No plan	None	None	500	MG
5db3f13e9c8c49faa4d92ab75c9fd29f	$2.82	$280.00	fee schedule	Facility	Outpatient	$0.50	636		No plan	5	gram	500	MG
c55536200ad449d6ad5efa87ccb83bd7	$2.82	$nan	fee schedule	Facility	Outpatient	$0.50	636		No plan	None	None	500	MG
554be38d127c4de18ea715c6eb1e3208	$2.82	$280.00	fee schedule	Facility	Outpatient	$0.50	636		No plan	5	gram	500	MG
ea6d06def1b44ef892ff8785f3531ceb	$5.64	$1410.00	fee schedule	Facility	Outpatient	$0.50	636		No plan	2	gram	500	MG
1521df2d834444cf8f76a0d634a4551c	$11.28	$1410.00	fee schedule	Facility	Outpatient	$0.50	636		No plan	4	gram	500	MG
3d1ad051d2724740ab51d4bd8908e069	$11.28	$1410.00	fee schedule	Facility	Outpatient	$0.50	636		No plan	4	gram	500	MG

---

Sample 20/55

Payer: 12 | Provider: Robert Packer Hospital | Code: J9228

Results:

• Number of rate records: 2
• Unique negotiated rates: 2
• ASP Payment Limit: $183.41
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $22098.00
• Max negotiated_dollar by contract_methodology:
  • fee schedule: $35356.80
• Median dosage_std_dollar by payer_product_network:
  • Unsorted: $176.78
• Max dosage_std_dollar by contract_methodology:
  • fee schedule: $176.78

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
979ef37f4ed54472aeddab3484412ace	$8839.20	$176.78	fee schedule	Facility	Outpatient	$183.41	636		No plan	50	milligram	1	MG
90cfebf528984fc294162915e0b69f1c	$35356.80	$176.78	fee schedule	Facility	Outpatient	$183.41	636		No plan	200	milligram	1	MG

---

Provider ID: 6813

Sample 21/55

Payer: 12 | Provider: UPMC West Shore | Code: J9317

Results:

• Number of rate records: 2
• Unique negotiated rates: 2
• ASP Payment Limit: $36.26
• Median negotiated_dollar by payer_product_network:
  • PPO: $1562.51
  • Unsorted: $2043.28
• Max negotiated_dollar by contract_methodology:
  • percent of total billed charges: $2043.28
• Median dosage_std_dollar by payer_product_network:
  • PPO: $21.70
  • Unsorted: $28.38
• Max dosage_std_dollar by contract_methodology:
  • percent of total billed charges: $28.38

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
7ec7a0edbb8846958b69565d8d66197c	$1562.51	$21.70	percent of total billed charges	Facility	Outpatient	$36.26	636		PPO	180	milligram	2.5	MG
97e86750f9ce4438b4b30b1f5f2aa465	$2043.28	$28.38	percent of total billed charges	Facility	Outpatient	$36.26	636		COMMERCIAL	180	milligram	2.5	MG

---

Sample 22/55

Payer: 12 | Provider: UPMC West Shore | Code: J9390

Results:

• Number of rate records: 14
• Unique negotiated rates: 8
• ASP Payment Limit: $1.96
• Median negotiated_dollar by payer_product_network:
  • PPO: $11.70
  • Unsorted: $15.30
• Max negotiated_dollar by contract_methodology:
  • percent of total billed charges: $21.25
• Median dosage_std_dollar by payer_product_network:
  • PPO: $11.70
  • Unsorted: $15.30
• Max dosage_std_dollar by contract_methodology:
  • percent of total billed charges: $21.30

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
32d72b2b54884829acdd182fdcf9a719	$5.70	$5.70	percent of total billed charges	Facility	Outpatient	$1.96	636		PPO	10	milligrams per milliliter	10	MG
d080a2da7bbc4a53867afcb200622481	$7.45	$7.50	percent of total billed charges	Facility	Outpatient	$1.96	636		COMMERCIAL	10	milligrams per milliliter	10	MG
419130014bfa4713a45b4fe1940face2	$11.70	$11.70	percent of total billed charges	Facility	Outpatient	$1.96	636		PPO	10	milligrams per milliliter	10	MG
fe1a3991255844978662e319c0e1b75e	$11.70	$11.70	percent of total billed charges	Facility	Outpatient	$1.96	636		PPO	10	milligrams per milliliter	10	MG
cf09c2d40cf240d79ed15f13ba12de0e	$11.70	$11.70	percent of total billed charges	Facility	Outpatient	$1.96	636		PPO	10	milligrams per milliliter	10	MG
9a21f1d36c91463abeac5c76374e88c5	$11.70	$11.70	percent of total billed charges	Facility	Outpatient	$1.96	636		PPO	10	milligrams per milliliter	10	MG
4e756c9d4cf24086959b010b9b10d462	$13.00	$13.00	percent of total billed charges	Facility	Outpatient	$1.96	636		PPO	10	milligrams per milliliter	10	MG
6c8d9c6c362546a8b4d8380ef852dc8a	$15.30	$15.30	percent of total billed charges	Facility	Outpatient	$1.96	636		COMMERCIAL	10	milligrams per milliliter	10	MG
172608b16c1c445b816d96114783d4d1	$15.30	$15.30	percent of total billed charges	Facility	Outpatient	$1.96	636		COMMERCIAL	10	milligrams per milliliter	10	MG
7abf017f8cec4bc1bd3af7291c3de2a5	$15.30	$15.30	percent of total billed charges	Facility	Outpatient	$1.96	636		COMMERCIAL	10	milligrams per milliliter	10	MG
b0a5a807797946cf92e6c139dfc08fd9	$15.30	$15.30	percent of total billed charges	Facility	Outpatient	$1.96	636		COMMERCIAL	10	milligrams per milliliter	10	MG
242228eca98b42cab91ce2bc89b92270	$16.25	$16.30	percent of total billed charges	Facility	Outpatient	$1.96	636		PPO	10	milligrams per milliliter	10	MG
bd2f941367704fd98e681270b70a7b30	$17.00	$17.00	percent of total billed charges	Facility	Outpatient	$1.96	636		COMMERCIAL	10	milligrams per milliliter	10	MG
ae195ac6eacc4f7cb5c183c8c5e3fa01	$21.25	$21.30	percent of total billed charges	Facility	Outpatient	$1.96	636		COMMERCIAL	10	milligrams per milliliter	10	MG

---

Sample 23/55

Payer: 12 | Provider: UPMC West Shore | Code: J1944

Results:

• Number of rate records: 8
• Unique negotiated rates: 6
• ASP Payment Limit: $3.33
• Median negotiated_dollar by payer_product_network:
  • PPO: $627.52
  • Unsorted: $820.60
• Max negotiated_dollar by contract_methodology:
  • percent of total billed charges: $821.23
• Median dosage_std_dollar by payer_product_network:
  • PPO: $0.83
  • Unsorted: $1.08
• Max dosage_std_dollar by contract_methodology:
  • percent of total billed charges: $1.86

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
e66c9fc599c04b4a9516f77fb14b93f3	$621.13	$0.58	percent of total billed charges	Facility	Outpatient	$3.33	636		PPO	1064	milligram	1	MG
7484440b8bdf4168b7ffa144a12b54a5	$627.52	$1.42	percent of total billed charges	Facility	Outpatient	$3.33	636		PPO	441	milligram	1	MG
95181faf80a246c8a987660400715557	$627.52	$0.71	percent of total billed charges	Facility	Outpatient	$3.33	636		PPO	882	milligram	1	MG
785790d283f64776964d37bc20adfbb3	$628.00	$0.95	percent of total billed charges	Facility	Outpatient	$3.33	636		PPO	662	milligram	1	MG
51facc6f90a2447896a8cce754c49284	$812.25	$0.76	percent of total billed charges	Facility	Outpatient	$3.33	636		COMMERCIAL	1064	milligram	1	MG
e9d1bce3a4574acdb71a11034a9ab641	$820.60	$1.86	percent of total billed charges	Facility	Outpatient	$3.33	636		COMMERCIAL	441	milligram	1	MG
30a771dcb20440f584d18bef75b0f0c6	$820.60	$0.93	percent of total billed charges	Facility	Outpatient	$3.33	636		COMMERCIAL	882	milligram	1	MG
463bf91637ec434bb4194fdbd69645e1	$821.23	$1.24	percent of total billed charges	Facility	Outpatient	$3.33	636		COMMERCIAL	662	milligram	1	MG

---

Sample 24/55

Payer: 12 | Provider: UPMC West Shore | Code: J9312

Results:

• Number of rate records: 4
• Unique negotiated rates: 2
• ASP Payment Limit: $75.93
• Median negotiated_dollar by payer_product_network:
  • PPO: $61.07
  • Unsorted: $79.86
• Max negotiated_dollar by contract_methodology:
  • percent of total billed charges: $79.86
• Median dosage_std_dollar by payer_product_network:
  • PPO: $61.10
  • Unsorted: $79.90
• Max dosage_std_dollar by contract_methodology:
  • percent of total billed charges: $79.90

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
809bcd4116064f03b23c47d1eddfeb49	$61.07	$61.10	percent of total billed charges	Facility	Outpatient	$75.93	636		PPO	10	milligrams per milliliter	10	MG
f6c9af6147724455a9f92a9a8ac8f369	$61.07	$61.10	percent of total billed charges	Facility	Outpatient	$75.93	636		PPO	10	milligrams per milliliter	10	MG
eb9635764c7448fe82756b4eabe1d71e	$79.86	$79.90	percent of total billed charges	Facility	Outpatient	$75.93	636		COMMERCIAL	10	milligrams per milliliter	10	MG
34fd5c4aa7df411b836ce9a7b261e9d5	$79.86	$79.90	percent of total billed charges	Facility	Outpatient	$75.93	636		COMMERCIAL	10	milligrams per milliliter	10	MG

---

Sample 25/55

Payer: 12 | Provider: UPMC West Shore | Code: J2310

Results:

• Number of rate records: 130
• Unique negotiated rates: 16
• ASP Payment Limit: $9.21
• Median negotiated_dollar by payer_product_network:
  • PPO: $6.50
  • Unsorted: $8.50
• Max negotiated_dollar by contract_methodology:
  • percent of total billed charges: $14.02
• Median dosage_std_dollar by payer_product_network:
  • PPO: $16.25
  • Unsorted: $21.25
• Max dosage_std_dollar by contract_methodology:
  • percent of total billed charges: $33.65

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
99f35fad21d442ab9cbe9bd647d4a1f0	$2.23	$5.58	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
cffd4e6bac2944cd86816db17ac3ea8f	$2.92	$7.30	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
48fa65f85db84572902b9b3bbf6e468d	$3.25	$8.13	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
faed3c5401cc4e6dbbb6a0c28489c477	$3.90	$9.75	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
7b5d7995c1234b89ab7d71bb0e506a4c	$3.90	$9.75	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
2deb1d60377d471499df9b0c860f6312	$3.90	$9.75	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
eb27b49b43454c709c7228ac47fcf60c	$3.90	$9.75	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
aeee3f079f1c4b9faf154d7e7f31ce64	$3.90	$9.75	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
29b707b0a9c74bdd88b32ab990159813	$3.90	$9.75	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
eeeb5b5732e44064be771cc2625b6791	$3.90	$9.75	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
76eb6023f5c5481aa681f77575fa51c9	$3.90	$9.75	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
9a89757df80d4ec48b5848c4fe06ef33	$3.90	$9.75	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
a1713f812c394b69b0a2d140f757eddd	$3.90	$9.75	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
4ad41b78a1654d7796b4f3ba7664eec4	$3.90	$9.75	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
9afcbcada16349b68c3824ad20e9cca3	$4.25	$10.63	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
5b1c2af8cc5e4b65a182f1a234e6ab9f	$5.10	$12.75	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
ed0c0046bc2c4a0e8cf0149e99735323	$5.10	$12.75	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
2ec336261e054772b20ed64056c46c51	$5.10	$12.75	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
bdf2dc85154843e5985fa9a73bab45af	$5.10	$12.75	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
9459f6e964064aebb5895274d19456ee	$5.10	$12.75	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
6060fce2e0bf4bd694369f47aaa8467f	$5.10	$12.75	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
82cd6d4f9822432ea2b28db4d90f96c2	$5.10	$12.75	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
1c20d7dc1cd04463b6e098b0449b930c	$5.10	$12.75	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
3a7f762274834596a2244141c3689857	$5.10	$12.75	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
cc561cdaba7f4bc3a73da2426388780e	$5.10	$12.75	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
a092751f0e954b248011f4d7b51fc8a4	$5.10	$12.75	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
1d96849a4da84660a045d3d1b4a71845	$6.50	$16.25	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
3fd37aa6aa6f48dd852f3b7b11a6de68	$6.50	$16.25	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
4fbec6e430a142fc95c3d103ee8620a2	$6.50	$16.25	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
77901e61b58c45f2bdbb380cea9823ad	$6.50	$16.25	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
f74698cdc05d4ad5a86ebf82e5433405	$6.50	$16.25	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
ed0c44c680e04cd1ac7c0896a61f6f06	$6.50	$16.25	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
e06341e6548c41cfb8efc1393b97e375	$6.50	$16.25	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
177be48498b04d0cb657f43cca9ddac8	$6.50	$16.25	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
a56d2e8d23464b5e9596cfdba1f0ebe8	$6.50	$16.25	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
bcaca0e747914a1090c36d4c8e8b87bf	$6.50	$16.25	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
214089ddf57d4dca9a161bbaefc12f80	$6.50	$16.25	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
1f6724027f374f2e8e4699d122621822	$6.50	$16.25	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
0ac6d4342dbe4a19b158028e7cf084dd	$6.50	$16.25	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
b2b88bcd413245fb803e1bf1990b3b3e	$6.50	$16.25	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
ed386c60b4c84f1cb61ae9b8bf90097d	$6.50	$16.25	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
961d863e3ec24c319cf4fc7913b0171f	$6.50	$16.25	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
3a7d40803f984103a6731f9a7ca66a19	$6.50	$16.25	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
23975b0932b1477791f649690af1ff13	$6.50	$16.25	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
cdc948f0dc54479f982d0df2f26bd4c8	$6.50	$16.25	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
de3ba782260842ffb3766ab44b389d06	$6.50	$16.25	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
d360ec17a5364529934f73c80a7b02ac	$6.50	$16.25	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
b03f9eba9b4e433b9f992ec0ba8e9e85	$6.50	$16.25	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
de750b29e5e2435b98c6f8ce15af9dab	$6.50	$16.25	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
daf2fec3e49547d9a410eb55394f40f1	$6.50	$16.25	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
72d01175d739462fa946c42463d572cf	$6.50	$16.25	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
4ee2f325da4144fc9c5f5f5d6ff62775	$6.50	$16.25	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
02f8f90de1bf47fb8904a6c9c9d16fca	$6.50	$16.25	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
e6c2ca389c474257bce441dedb46747b	$6.50	$16.25	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
3e3d1f3555694eadbfa3895f719858be	$6.50	$16.25	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
6eb0b36db2024eeca9081d1041165b1e	$6.50	$16.25	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
ee50b633e7c841c1880fbb5fc5ad2136	$6.50	$16.25	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
3046fd9ca29a4634883ba24300054587	$6.50	$16.25	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
c92d09a72bea40eda73cc1625df1097c	$7.72	$19.30	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
8ac61b1d62af4505aad1ae456beeecf4	$8.50	$21.25	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
9667e6145c66439992b19a8bcfde2952	$8.50	$21.25	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
84aa31c0ca3747d69f99c5439824b94e	$8.50	$21.25	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
a648bdf16f8942a9b77495909945ef56	$8.50	$21.25	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
80fd562a0d6b4a659dc402766f965cf2	$8.50	$21.25	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
eafebfcbb6fa4221bd72e7d72e9b7944	$8.50	$21.25	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
0fbd6ed2c122470c81ca554b4a3c85bb	$8.50	$21.25	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
9b75dd49330b4edcb361af34aee311cd	$8.50	$21.25	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
7ef8a611505845b4bf61e6ece07468ae	$8.50	$21.25	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
ffebabe24a6c4de2a92c0f9c4477fc65	$8.50	$21.25	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
f83f5e3aff724f0f927d7517ddfd8851	$8.50	$21.25	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
aa156a7cb5ef419996237114cda50fa7	$8.50	$21.25	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
b62d7bd977214b00ad0f36b75058e1f3	$8.50	$21.25	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
b224928dc3a34d58ad1a8740c1e79be1	$8.50	$21.25	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
f9337e830e7c476c8db15a17094db97e	$8.50	$21.25	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
f22d57f4db4442e1b2276bdcf06d6291	$8.50	$21.25	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
58bc14378ae7400f9a6bd334da7efcc5	$8.50	$21.25	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
7518ce4e90874d52b62958c2599d759a	$8.50	$21.25	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
01c2bef3f810411889f90f2fb4ffaefe	$8.50	$21.25	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
6f523408f37b4f5989501366957d0478	$8.50	$21.25	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
54d75ebfd4354d5fa5a9bd6c037d981f	$8.50	$21.25	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
5ec98306137343b680232208ea784c96	$8.50	$21.25	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
e2d3f55acd9841ceb06e14d68d2b2e42	$8.50	$21.25	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
7be8570a9298415abe82dac60530ec62	$8.50	$21.25	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
ca589e51508249f1b3bf0dc7b1afb836	$8.50	$21.25	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
194e877636c644a6b930d7e36cc2d0f5	$8.50	$21.25	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
3c0d35469ee34f48902b2cbc1eed17d1	$8.50	$21.25	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
fb1cfc4f7a714bc19ff29349524de087	$8.50	$21.25	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
bc1f49736d9c4a4c8e7f335b148d1ddf	$8.50	$21.25	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
9f20c25e27224023997afd69817b9e01	$8.50	$21.25	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
754cc164ddce4ed1860565aefd7f67c0	$8.50	$21.25	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
277be49a4e3c4f57be57b76306272a87	$8.50	$21.25	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
e30f4bb98f91406a943810c82b3fed78	$10.09	$25.23	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
7200022f5cab49148619398c6d558605	$10.13	$25.33	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
ed388e6de2834106a8905b82ba346304	$10.13	$25.33	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
3f6a8d3567e14b78862ff82d66e75308	$10.13	$25.33	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
e5ccab79a5114b7ba4e2d7d26c931d2f	$10.13	$25.33	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
7f2ff71f57c54b7fa3fce9972f4a54fc	$10.13	$25.33	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
3b21433d884c4e81ab4ec39ab3455031	$10.13	$25.33	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
8344145629e0456ebc9dc5ed80a36f6b	$10.29	$25.73	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
c5fd693c50f44dd0aa8fe6299725879e	$10.29	$25.73	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
cbfa1756c7ed4325ab556f28bcf6faea	$10.29	$25.73	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
be06f45102c646acaab426a0866e20e5	$10.29	$25.73	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
a71a160a922d4998992585e2d1348d6d	$10.29	$25.73	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
6ca99d71426b41c28baccc0733b1a2c2	$10.29	$25.73	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
ff1efc4321bb40cc922c185470f34878	$10.29	$25.73	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
695d6da088f8435fa22b891b6c62d390	$10.29	$25.73	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
2950f19f20aa4d869d4f974f34daa1f9	$10.29	$25.73	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
83840b0725cc40b3ad73e3b3f3769f1c	$10.29	$25.73	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
93c55c05f83142aabe38cbaffe2ef631	$10.29	$25.73	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	0.4	milligrams per milliliter	1	MG
968130dc68e54379a76fdb430c9754b4	$10.72	$10.72	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	1	milligrams per milliliter	1	MG
4245aa8071c14924b959bf15a8f00d77	$10.72	$10.72	percent of total billed charges	Facility	Outpatient	$9.21	636		PPO	1	milligrams per milliliter	1	MG
687927d429a14123a9ad0e1877608a9c	$13.25	$33.13	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
25bcf0655b0a499bb852d53a2d6be337	$13.25	$33.13	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
30f61e3943af48058b01ef8a62a62047	$13.25	$33.13	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
392ad55e0a0d43389582ea045099cbc1	$13.25	$33.13	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
98fbf90126d845b18dc8233f44083cfd	$13.25	$33.13	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
e7ffcfe7ac9149cdb780e40562b0717a	$13.25	$33.13	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
2d0caf6036694e5abea60878b7ed7f1e	$13.46	$33.65	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
07d7c4af708e42fcb3622a4cd8125d7d	$13.46	$33.65	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
d49eac3dad2a4d4c965fd70416d3787b	$13.46	$33.65	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
0d375830598b4fc286ae49c8c5454cce	$13.46	$33.65	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
7fb3053810ef4d63b5ffb4ca4899d8d6	$13.46	$33.65	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
26c9bd3c7bdb4f23a2458acd7b48377a	$13.46	$33.65	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
9607332851e542f78ab4f70c6e2bece7	$13.46	$33.65	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
7fdf9ff20a864957b94362b205c23c9c	$13.46	$33.65	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
902c99bb8fbe4bd1b9296e9eddfd8552	$13.46	$33.65	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
23ce158253b0454ab520f411668ed6e0	$13.46	$33.65	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
9d0b97112baf44099962b145ff62683f	$13.46	$33.65	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	0.4	milligrams per milliliter	1	MG
f4f50c3519264baebbee8c62dc41a4d7	$14.02	$14.02	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	1	milligrams per milliliter	1	MG
b0861edc4c684ff6ba584430c20a6161	$14.02	$14.02	percent of total billed charges	Facility	Outpatient	$9.21	636		COMMERCIAL	1	milligrams per milliliter	1	MG

---

Provider ID: 1113

Sample 26/55

Payer: 643 | Provider: Wilkes-Barre General Hospital | Code: J0130

Results:

• Number of rate records: 2
• Unique negotiated rates: 2
• ASP Payment Limit: $1429.07
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $9859.54
• Max negotiated_dollar by contract_methodology:
  • percent of total billed charges: $11219.48
• Median dosage_std_dollar by payer_product_network:
  • Unsorted: $9859.55
• Max dosage_std_dollar by contract_methodology:
  • percent of total billed charges: $11219.50

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
3ce14ff35b2c4b36bf111589332a89a5	$8499.60	$8499.60	percent of total billed charges	Facility	Outpatient	$1429.07	250		UHC NBR	10	milligram	10	MG
20a4cc2fe4494d1696997f6d359dd899	$11219.48	$11219.50	percent of total billed charges	Facility	Outpatient	$1429.07	250		UHC APA	10	milligram	10	MG

---

Sample 27/55

Payer: 56 | Provider: Wilkes-Barre General Hospital | Code: J1171

Results:

• Number of rate records: 5
• Unique negotiated rates: 5
• ASP Payment Limit: $0.09
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $0.78
• Max negotiated_dollar by contract_methodology:
  • percent of total billed charges: $3.97
• Median dosage_std_dollar by payer_product_network:
  • Unsorted: $0.78
• Max dosage_std_dollar by contract_methodology:
  • percent of total billed charges: $3.97

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
34ea643bfeb74f37a13471bcd0fc4302	$0.08	$0.08	percent of total billed charges	Facility	Outpatient	$0.09	250		IBC CHS EMPLOYEE	0.1	milligram	0.1	MG
3ba8e24dc504483ab52ad2f84cbe3f64	$0.18	$0.18	percent of total billed charges	Facility	Outpatient	$0.09	250		IBC CHS EMPLOYEE	0.1	milligram	0.1	MG
d94eee3145f04c059bba7a0ed97fe806	$0.78	$0.78	percent of total billed charges	Facility	Outpatient	$0.09	250		IBC CHS EMPLOYEE	0.1	milligram	0.1	MG
cc259828670d40ee8728c56680412068	$1.51	$1.51	percent of total billed charges	Facility	Outpatient	$0.09	250		IBC CHS EMPLOYEE	0.1	milligram	0.1	MG
8eef035c4c1b418698679934d4b2353a	$3.97	$3.97	percent of total billed charges	Facility	Outpatient	$0.09	250		IBC CHS EMPLOYEE	0.1	milligram	0.1	MG

---

Sample 28/55

Payer: 1109 | Provider: Wilkes-Barre General Hospital | Code: J7517

Results:

• Number of rate records: 3
• Unique negotiated rates: 3
• ASP Payment Limit: $0.16
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $13.27
• Max negotiated_dollar by contract_methodology:
  • percent of total billed charges: $100.97
• Median dosage_std_dollar by payer_product_network:
  • Unsorted: $12.50
• Max dosage_std_dollar by contract_methodology:
  • percent of total billed charges: $100.00

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
5b6210d65e1d4f3d9fc1fd15ca0e5780	$9.19	$10.00	percent of total billed charges	Facility	Outpatient	$0.16	250		MULTIPLAN PRIMARY	250	milligram	250	MG
4aeb79c1ac3245d69737aa878233398b	$13.27	$12.50	percent of total billed charges	Facility	Outpatient	$0.16	250		MULTIPLAN PRIMARY	250	milligram	250	MG
df7edfabe5e64c3d8f95682c853d0f32	$100.97	$100.00	percent of total billed charges	Facility	Outpatient	$0.16	250		MULTIPLAN PRIMARY	250	milligram	250	MG

---

Sample 29/55

Payer: 7 | Provider: Wilkes-Barre General Hospital | Code: J2850

Results:

• Number of rate records: 3
• Unique negotiated rates: 3
• ASP Payment Limit: $34.78
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $112.36
• Max negotiated_dollar by contract_methodology:
  • percent of total billed charges: $321.69
• Median dosage_std_dollar by payer_product_network:
  • Unsorted: $112.36
• Max dosage_std_dollar by contract_methodology:
  • percent of total billed charges: $321.69

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
a815a6d988f64dafaa406a63bca8c352	$89.47	$89.47	percent of total billed charges	Facility	Outpatient	$34.78	250		AETNA HPN	1	microgram	1	MCG
0438788c3bae4af28f880f3bcb6998f2	$112.36	$112.36	percent of total billed charges	Facility	Outpatient	$34.78	250		AETNA	1	microgram	1	MCG
d4ee829fe04d49fba71732a31b62d5c0	$321.69	$321.69	percent of total billed charges	Facility	Outpatient	$34.78	250		AETNA NAB FH	1	microgram	1	MCG

---

Sample 30/55

Payer: 7 | Provider: Wilkes-Barre General Hospital | Code: J1171

Results:

• Number of rate records: 15
• Unique negotiated rates: 15
• ASP Payment Limit: $0.09
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $0.70
• Max negotiated_dollar by contract_methodology:
  • percent of total billed charges: $10.23
• Median dosage_std_dollar by payer_product_network:
  • Unsorted: $0.70
• Max dosage_std_dollar by contract_methodology:
  • percent of total billed charges: $10.23

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
c0e2dd82b05940f7b6a61d65cd1962d0	$0.06	$0.06	percent of total billed charges	Facility	Outpatient	$0.09	250		AETNA HPN	0.1	milligram	0.1	MG
32913e6a1e0247f99bd7d9e2d90158e4	$0.07	$0.07	percent of total billed charges	Facility	Outpatient	$0.09	250		AETNA	0.1	milligram	0.1	MG
0fe7f71a4cdc48439fca6e26ce9f0cd7	$0.13	$0.13	percent of total billed charges	Facility	Outpatient	$0.09	250		AETNA HPN	0.1	milligram	0.1	MG
567121c6858748c2adf65723d2df3c8a	$0.16	$0.16	percent of total billed charges	Facility	Outpatient	$0.09	250		AETNA	0.1	milligram	0.1	MG
3f832810f9c34230bd1efce447cafcda	$0.20	$0.20	percent of total billed charges	Facility	Outpatient	$0.09	250		AETNA NAB FH	0.1	milligram	0.1	MG
9bd7325aeb3d425e89b88d74fd93f850	$0.46	$0.46	percent of total billed charges	Facility	Outpatient	$0.09	250		AETNA NAB FH	0.1	milligram	0.1	MG
0bc0ba67cd8e45f093a02cdf33dd964e	$0.56	$0.56	percent of total billed charges	Facility	Outpatient	$0.09	250		AETNA HPN	0.1	milligram	0.1	MG
36cb61c470514618bec2642cb64783ca	$0.70	$0.70	percent of total billed charges	Facility	Outpatient	$0.09	250		AETNA	0.1	milligram	0.1	MG
7107685dfd6441fa9a124901ae28387e	$1.08	$1.08	percent of total billed charges	Facility	Outpatient	$0.09	250		AETNA HPN	0.1	milligram	0.1	MG
8873bfd79a6b47aeb30f57e080bb9f9b	$1.36	$1.36	percent of total billed charges	Facility	Outpatient	$0.09	250		AETNA	0.1	milligram	0.1	MG
f8b8a52e9f464b3eb31473155068b3e3	$2.00	$2.00	percent of total billed charges	Facility	Outpatient	$0.09	250		AETNA NAB FH	0.1	milligram	0.1	MG
122b81022dfc46378a6e804b0a38c12d	$2.85	$2.85	percent of total billed charges	Facility	Outpatient	$0.09	250		AETNA HPN	0.1	milligram	0.1	MG
0203a8c3fc9b489b82e6379859e672b9	$3.57	$3.57	percent of total billed charges	Facility	Outpatient	$0.09	250		AETNA	0.1	milligram	0.1	MG
7dc4e3bc551741cd8e14de54bcce0288	$3.90	$3.90	percent of total billed charges	Facility	Outpatient	$0.09	250		AETNA NAB FH	0.1	milligram	0.1	MG
b3c39383845b44469b571cfd7979289d	$10.23	$10.23	percent of total billed charges	Facility	Outpatient	$0.09	250		AETNA NAB FH	0.1	milligram	0.1	MG

---

Provider ID: 1173

Sample 31/55

Payer: 7 | Provider: St. Lukes Miners Campus | Code: J9177

Results:

• Number of rate records: 2
• Unique negotiated rates: 2
• ASP Payment Limit: $36.66
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $6606.95
• Max negotiated_dollar by contract_methodology:
  • percent of total billed charges: $7928.35
• Median dosage_std_dollar by payer_product_network:
  • Unsorted: $66.07
• Max dosage_std_dollar by contract_methodology:
  • percent of total billed charges: $66.07

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
9fcd90756b6a440682fc83d1c93eea73	$5285.56	$66.07	percent of total billed charges	Facility	Outpatient	$36.66	636		COMMERCIAL	20	milligram	0.25	MG
cca5d2b1b00e4768bf1121f6b23108ff	$7928.35	$66.07	percent of total billed charges	Facility	Outpatient	$36.66	636		COMMERCIAL	30	milligram	0.25	MG

---

Sample 32/55

Payer: 567 | Provider: St. Lukes Miners Campus | Code: J1265

Results:

• Number of rate records: 3
• Unique negotiated rates: 2
• ASP Payment Limit: $0.66
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $0.39
• Max negotiated_dollar by contract_methodology:
  • percent of total billed charges: $0.85
• Median dosage_std_dollar by payer_product_network:
  • Unsorted: $3.20
• Max dosage_std_dollar by contract_methodology:
  • percent of total billed charges: $3.20

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
71f5979839864d7fa30ad55d37a32b9e	$0.39	$3.20	percent of total billed charges	Facility	Outpatient	$0.66	636		COMMERCIAL	5	milligrams per milliliter	40	MG
f8c97155099c44eabc275da128724f62	$0.39	$3.20	percent of total billed charges	Facility	Outpatient	$0.66	637		COMMERCIAL	5	milligrams per milliliter	40	MG
4876deaa39f94132a0d5d566f28766d3	$0.85	$0.80	percent of total billed charges	Facility	Outpatient	$0.66	636		COMMERCIAL	40	milligrams per milliliter	40	MG

---

Sample 33/55

Payer: 111 | Provider: St. Lukes Miners Campus | Code: J1650

Results:

• Number of rate records: 7
• Unique negotiated rates: 7
• ASP Payment Limit: $0.57
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $11.77
• Max negotiated_dollar by contract_methodology:
  • percent of total billed charges: $17.93
• Median dosage_std_dollar by payer_product_network:
  • Unsorted: $1.40
• Max dosage_std_dollar by contract_methodology:
  • percent of total billed charges: $3.90

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
0afe097bc00b4f7097f309e146b4383c	$9.75	$2.40	percent of total billed charges	Facility	Outpatient	$0.57	636		COMMERCIAL	40	milligram	10	MG
b9de3bb427364296879347d989000dfa	$11.29	$1.40	percent of total billed charges	Facility	Outpatient	$0.57	636		COMMERCIAL	80	milligram	10	MG
0b94cf53987b42ea92d008f942caa422	$11.71	$2.00	percent of total billed charges	Facility	Outpatient	$0.57	636		COMMERCIAL	60	milligram	10	MG
717c20d27a5f46a5811a76e792aa9cc8	$11.77	$3.90	percent of total billed charges	Facility	Outpatient	$0.57	636		COMMERCIAL	30	milligram	10	MG
192bea71127c42ec83b011ce5703bdc2	$11.90	$1.20	percent of total billed charges	Facility	Outpatient	$0.57	636		COMMERCIAL	100	milligrams per milliliter	10	MG
a6cb78a5cb884ba58958f15a9acdba8b	$15.18	$0.50	percent of total billed charges	Facility	Outpatient	$0.57	636		COMMERCIAL	300	milligram	10	MG
12b100dd568640bdb6ed729d0d9ab307	$17.93	$1.20	percent of total billed charges	Facility	Outpatient	$0.57	636		COMMERCIAL	150	milligrams per milliliter	10	MG

---

Sample 34/55

Payer: 7 | Provider: St. Lukes Miners Campus | Code: J9208

Results:

• Number of rate records: 3
• Unique negotiated rates: 3
• ASP Payment Limit: $23.50
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $2.19
• Max negotiated_dollar by contract_methodology:
  • percent of total billed charges: $2.44
• Median dosage_std_dollar by payer_product_network:
  • Unsorted: $1.97
• Max dosage_std_dollar by contract_methodology:
  • percent of total billed charges: $2.19

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
eed982539e7f4b5e88d1d17bd549ea63	$1.97	$1.97	percent of total billed charges	Facility	Outpatient	$23.50	636		COMMERCIAL	1	gram	1	GM
b88e485931d04cef8676de0e9e8dd3e4	$2.19	$2.19	percent of total billed charges	Facility	Outpatient	$23.50	636		COMMERCIAL	1	gram	1	GM
ab0b62ca4da94c21a22e6a823cd2980f	$2.44	$0.81	percent of total billed charges	Facility	Outpatient	$23.50	636		COMMERCIAL	3	gram	1	GM

---

Sample 35/55

Payer: 76 | Provider: St. Lukes Miners Campus | Code: J2260

Results:

• Number of rate records: 3
• Unique negotiated rates: 2
• ASP Payment Limit: $1.40
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $0.36
• Max negotiated_dollar by contract_methodology:
  • percent of total billed charges: $0.51
• Median dosage_std_dollar by payer_product_network:
  • Unsorted: $0.25
• Max dosage_std_dollar by contract_methodology:
  • percent of total billed charges: $0.35

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
62de31807dcd413980fbd801860778da	$0.36	$0.35	percent of total billed charges	Facility	Outpatient	$1.40	636		COMMERCIAL	5	milligram	5	MG
74dcb93128644388bd21e72a145b5680	$0.36	$nan	percent of total billed charges	Facility	Outpatient	$1.40	636		COMMERCIAL	None	None	5	MG
744ee3d613054f42b20362a49115c5bc	$0.51	$0.15	percent of total billed charges	Facility	Outpatient	$1.40	636		COMMERCIAL	20	milligram	5	MG

---

Provider ID: 1117

Sample 36/55

Payer: 111 | Provider: UPMC Harrisburg | Code: J3357

Results:

• Number of rate records: 2
• Unique negotiated rates: 2
• ASP Payment Limit: $155.88
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $18579.53
• Max negotiated_dollar by contract_methodology:
  • percent of total billed charges: $18579.54
• Median dosage_std_dollar by payer_product_network:
  • Unsorted: $309.66
• Max dosage_std_dollar by contract_methodology:
  • percent of total billed charges: $412.88

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
cc6fbb5d9a27490e86a91ae8843ac28a	$18579.53	$206.44	percent of total billed charges	Facility	Outpatient	$155.88	636		COMMERCIAL	90	milligrams per milliliter	1	MG
5608014eb4604349b7675ce9d4925abc	$18579.54	$412.88	percent of total billed charges	Facility	Outpatient	$155.88	636		COMMERCIAL	45	milligram	1	MG

---

Sample 37/55

Payer: 12 | Provider: UPMC Harrisburg | Code: J2001

Results:

• Number of rate records: 20
• Unique negotiated rates: 8
• ASP Payment Limit: $0.03
• Median negotiated_dollar by payer_product_network:
  • PPO: $0.03
  • Unsorted: $0.03
• Max negotiated_dollar by contract_methodology:
  • percent of total billed charges: $6.33
• Median dosage_std_dollar by payer_product_network:
  • PPO: $0.00
  • Unsorted: $0.00
• Max dosage_std_dollar by contract_methodology:
  • percent of total billed charges: $7.90

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
1551451409db488cb131f45eb6a71aa4	$0.02	$0.00	percent of total billed charges	Facility	Outpatient	$0.03	636		PPO	8	milligrams per milliliter	10	MG
501118139d86418c8f54daf1a723fb84	$0.02	$0.00	percent of total billed charges	Facility	Outpatient	$0.03	636		PPO	8	milligrams per milliliter	10	MG
8aa09766c1364b7a88f2401ddfeb8888	$0.02	$0.00	percent of total billed charges	Facility	Outpatient	$0.03	636		PPO	8	milligrams per milliliter	10	MG
a55e34fa4e9f4c459ac178e3c137580c	$0.03	$0.00	percent of total billed charges	Facility	Outpatient	$0.03	636		PPO	8	milligrams per milliliter	10	MG
1c74cb7326714572952801782b7cc9dd	$0.03	$0.00	percent of total billed charges	Facility	Outpatient	$0.03	636		COMMERCIAL	8	milligrams per milliliter	10	MG
5231dbaca2264ad5b3d63f95b79b6644	$0.03	$0.00	percent of total billed charges	Facility	Outpatient	$0.03	636		COMMERCIAL	8	milligrams per milliliter	10	MG
a9e62e91543243a6b9b6cb4f0a638468	$0.03	$0.00	percent of total billed charges	Facility	Outpatient	$0.03	636		PPO	8	milligrams per milliliter	10	MG
f9b48e6f21ef4c75995f947fc6719e6d	$0.03	$0.00	percent of total billed charges	Facility	Outpatient	$0.03	636		COMMERCIAL	8	milligrams per milliliter	10	MG
eca618dd3f314389915d10d8a5443a43	$0.03	$0.00	percent of total billed charges	Facility	Outpatient	$0.03	636		COMMERCIAL	8	milligrams per milliliter	10	MG
53381be92e85468785275eb0e95c93bd	$0.03	$0.00	percent of total billed charges	Facility	Outpatient	$0.03	636		COMMERCIAL	8	milligrams per milliliter	10	MG
e69dd056dc4740dab9f9262c8b58eb33	$0.03	$0.00	percent of total billed charges	Facility	Outpatient	$0.03	636		PPO	8	milligrams per milliliter	10	MG
49f40fccffbc4032a6d40032cfe1a404	$0.03	$0.00	percent of total billed charges	Facility	Outpatient	$0.03	636		COMMERCIAL	8	milligrams per milliliter	10	MG
3b782f8d42174f9a8577c373412ce110	$1.95	$1.00	percent of total billed charges	Facility	Outpatient	$0.03	636		PPO	20	milliliter	10	MG
0db4b6ac55fb4134a6d1be7895f8f7f8	$1.95	$0.40	percent of total billed charges	Facility	Outpatient	$0.03	636		PPO	50	milliliter	10	MG
00257d2aad004bde8855c6658d5dd572	$2.55	$1.30	percent of total billed charges	Facility	Outpatient	$0.03	636		COMMERCIAL	20	milliliter	10	MG
0ed166e0dd7c478b8631f7789fe930fe	$2.55	$0.50	percent of total billed charges	Facility	Outpatient	$0.03	636		COMMERCIAL	50	milliliter	10	MG
f297108c53b04225b3f91d11a78c66cd	$4.55	$2.30	percent of total billed charges	Facility	Outpatient	$0.03	636		PPO	20	milliliter	10	MG
330464b9a0424da6bc31ef710a027af4	$4.84	$6.10	percent of total billed charges	Facility	Outpatient	$0.03	636		PPO	8	milligrams per milliliter	10	MG
089bdd153f9a42c6b24de6f64b027d4a	$5.95	$3.00	percent of total billed charges	Facility	Outpatient	$0.03	636		COMMERCIAL	20	milliliter	10	MG
32c4e1cfbff94e27b25c67e6370bc001	$6.33	$7.90	percent of total billed charges	Facility	Outpatient	$0.03	636		COMMERCIAL	8	milligrams per milliliter	10	MG

---

Sample 38/55

Payer: 12 | Provider: UPMC Harrisburg | Code: J3030

Results:

• Number of rate records: 6
• Unique negotiated rates: 2
• ASP Payment Limit: $51.89
• Median negotiated_dollar by payer_product_network:
  • PPO: $114.45
  • Unsorted: $149.66
• Max negotiated_dollar by contract_methodology:
  • percent of total billed charges: $149.66
• Median dosage_std_dollar by payer_product_network:
  • PPO: $114.48
  • Unsorted: $149.64
• Max dosage_std_dollar by contract_methodology:
  • percent of total billed charges: $149.64

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
ef9c52a36ac947a4aabb368b41a84841	$114.45	$114.48	percent of total billed charges	Facility	Outpatient	$51.89	636		PPO	6	milligram	6	MG
1d0a880df14e449d9d0ee072c8ca6699	$114.45	$114.48	percent of total billed charges	Facility	Outpatient	$51.89	636		PPO	6	milligram	6	MG
cf04d7b3e4794abe81267c99fb901d44	$114.45	$114.48	percent of total billed charges	Facility	Outpatient	$51.89	636		PPO	6	milligram	6	MG
8ded3878898243e7870ac8c290b26e69	$149.66	$149.64	percent of total billed charges	Facility	Outpatient	$51.89	636		COMMERCIAL	6	milligram	6	MG
fea5de15cf09491d84d862604740f493	$149.66	$149.64	percent of total billed charges	Facility	Outpatient	$51.89	636		COMMERCIAL	6	milligram	6	MG
b318f7e9aa9245ca95baf355a7149aba	$149.66	$149.64	percent of total billed charges	Facility	Outpatient	$51.89	636		COMMERCIAL	6	milligram	6	MG

---

Sample 39/55

Payer: 354 | Provider: UPMC Harrisburg | Code: J2710

Results:

• Number of rate records: 25
• Unique negotiated rates: 11
• ASP Payment Limit: $0.09
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $3.50
• Max negotiated_dollar by contract_methodology:
  • percent of total billed charges: $10.00
• Median dosage_std_dollar by payer_product_network:
  • Unsorted: $0.65
• Max dosage_std_dollar by contract_methodology:
  • percent of total billed charges: $2.21

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
4347a744cb544a4bb39d9c34682c4169	$0.42	$0.21	percent of total billed charges	Facility	Outpatient	$0.09	636		COMMERCIAL	1	milligrams per milliliter	0.5	MG
fd05a67941e3450f94ce474059f8ef4d	$0.49	$0.24	percent of total billed charges	Facility	Outpatient	$0.09	636		COMMERCIAL	1	milligrams per milliliter	0.5	MG
79f0e96dfd384ab68342e54fa1d863fa	$0.53	$0.27	percent of total billed charges	Facility	Outpatient	$0.09	636		COMMERCIAL	1	milligrams per milliliter	0.5	MG
a6ebc77718d7427fa0d89ab5d3599873	$0.53	$0.27	percent of total billed charges	Facility	Outpatient	$0.09	636		COMMERCIAL	1	milligrams per milliliter	0.5	MG
ad90b5b61189459a89b521ef1840fcbf	$0.57	$0.28	percent of total billed charges	Facility	Outpatient	$0.09	636		COMMERCIAL	1	milligrams per milliliter	0.5	MG
3423d2aa176e45ea8da0239556fc4501	$0.59	$0.29	percent of total billed charges	Facility	Outpatient	$0.09	636		COMMERCIAL	1	milligrams per milliliter	0.5	MG
19ade2aabbad4928b59b85633db0a409	$0.63	$0.32	percent of total billed charges	Facility	Outpatient	$0.09	636		COMMERCIAL	1	milligrams per milliliter	0.5	MG
18924547c261442f9838c87d22ca5b50	$0.63	$0.32	percent of total billed charges	Facility	Outpatient	$0.09	636		COMMERCIAL	1	milligrams per milliliter	0.5	MG
0c859ec559f04f06b2931890fffced3a	$1.29	$0.65	percent of total billed charges	Facility	Outpatient	$0.09	636		COMMERCIAL	1	milligrams per milliliter	0.5	MG
502aca459e8c48ab8cbe1f56910e04ea	$1.29	$0.65	percent of total billed charges	Facility	Outpatient	$0.09	636		COMMERCIAL	1	milligrams per milliliter	0.5	MG
0818acd76dbe4fa3b05a2c0617c840c6	$1.29	$0.65	percent of total billed charges	Facility	Outpatient	$0.09	636		COMMERCIAL	1	milligrams per milliliter	0.5	MG
2e4c6f692500474bbf16620f5d53b1b4	$1.29	$0.65	percent of total billed charges	Facility	Outpatient	$0.09	636		COMMERCIAL	1	milligrams per milliliter	0.5	MG
f19300c6e27f445abad9590c34ed1123	$3.50	$0.58	percent of total billed charges	Facility	Outpatient	$0.09	636		COMMERCIAL	3	milligram	0.5	MG
b38aaf984672484fb319ca948a1665f5	$3.50	$0.58	percent of total billed charges	Facility	Outpatient	$0.09	636		COMMERCIAL	3	milligram	0.5	MG
81e3372fde9c4502a31383ac1ab4abf8	$3.50	$0.58	percent of total billed charges	Facility	Outpatient	$0.09	636		COMMERCIAL	3	milligram	0.5	MG
b056cecd037d407fa42c962b346fbfba	$3.50	$0.58	percent of total billed charges	Facility	Outpatient	$0.09	636		COMMERCIAL	3	milligram	0.5	MG
16391e211fb544b3b9ed0232c6403271	$4.41	$2.21	percent of total billed charges	Facility	Outpatient	$0.09	636		COMMERCIAL	1	milligrams per milliliter	0.5	MG
e9f1f837202245339f20645acc370683	$6.72	$1.12	percent of total billed charges	Facility	Outpatient	$0.09	636		COMMERCIAL	3	milligram	0.5	MG
5fc81fa8767643a6aff43eefc3010b52	$6.72	$1.12	percent of total billed charges	Facility	Outpatient	$0.09	636		COMMERCIAL	3	milligram	0.5	MG
a017e6683168404b91361cf5fb4342ed	$6.72	$1.12	percent of total billed charges	Facility	Outpatient	$0.09	636		COMMERCIAL	3	milligram	0.5	MG
831310aaf069471ba17b05fda5cbe622	$6.72	$1.12	percent of total billed charges	Facility	Outpatient	$0.09	636		COMMERCIAL	3	milligram	0.5	MG
16255832a9524c14ad27c86168b4b8a8	$6.72	$1.12	percent of total billed charges	Facility	Outpatient	$0.09	636		COMMERCIAL	3	milligram	0.5	MG
23f7bb6cf80949c6b437b71e06a6de14	$6.72	$1.12	percent of total billed charges	Facility	Outpatient	$0.09	636		COMMERCIAL	3	milligram	0.5	MG
1bd6a224f6f043a4b6cd4f3ab4164351	$10.00	$1.00	percent of total billed charges	Facility	Outpatient	$0.09	636		COMMERCIAL	5	milligram	0.5	MG
d02873bce8124736908286707efd6d73	$10.00	$1.00	percent of total billed charges	Facility	Outpatient	$0.09	636		COMMERCIAL	5	milligram	0.5	MG

---

Sample 40/55

Payer: 7 | Provider: UPMC Harrisburg | Code: J0878

Results:

• Number of rate records: 60
• Unique negotiated rates: 32
• ASP Payment Limit: $0.03
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $42.94
• Max negotiated_dollar by contract_methodology:
  • percent of total billed charges: $273.09
• Median dosage_std_dollar by payer_product_network:
  • Unsorted: $0.20
• Max dosage_std_dollar by contract_methodology:
  • percent of total billed charges: $5.46

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
76051dfaa2a4493ea124e464548db501	$0.49	$0.49	percent of total billed charges	Facility	Outpatient	$0.03	636		ACO	1	milligrams per milliliter	1	MG
660c6e954d7245b8921023d8566f7870	$0.52	$0.52	percent of total billed charges	Facility	Outpatient	$0.03	636		PEBTF ACO	1	milligrams per milliliter	1	MG
fdd696bf31a14d0b9346322f7f1ae2a9	$0.61	$0.61	percent of total billed charges	Facility	Outpatient	$0.03	636		COMMERCIAL	1	milligrams per milliliter	1	MG
76e6b4a241254f08bba6b90edb57515d	$1.57	$0.00	percent of total billed charges	Facility	Outpatient	$0.03	636		ACO	5000.0	milligrams per milliliter	1	MG
d9272a4ba9564dec90a7a7792f656afe	$1.67	$0.00	percent of total billed charges	Facility	Outpatient	$0.03	636		PEBTF ACO	5000.0	milligrams per milliliter	1	MG
40dddd375fb64aba9304ee1a6f95d4a5	$1.96	$0.00	percent of total billed charges	Facility	Outpatient	$0.03	636		COMMERCIAL	5000.0	milligrams per milliliter	1	MG
467e1072db8844bf91d08259b83cc62a	$11.78	$0.02	percent of total billed charges	Facility	Outpatient	$0.03	636		ACO	500	milligram	1	MG
dd3147411e044b19971668cbc391efb0	$12.28	$0.25	percent of total billed charges	Facility	Outpatient	$0.03	636		ACO	50	milligrams per milliliter	1	MG
a1fc9582be9f49eca22d6a8c67bee9cb	$12.28	$0.02	percent of total billed charges	Facility	Outpatient	$0.03	636		ACO	500	milligram	1	MG
0f79da945919403d843bdbcd521e1aeb	$12.28	$0.02	percent of total billed charges	Facility	Outpatient	$0.03	636		ACO	500	milligram	1	MG
92f864a42d324d62aadf7bb30bd0bfc6	$12.50	$0.03	percent of total billed charges	Facility	Outpatient	$0.03	636		PEBTF ACO	500	milligram	1	MG
dc0b90cad72c45969bab04eb1ed58dac	$13.02	$0.26	percent of total billed charges	Facility	Outpatient	$0.03	636		PEBTF ACO	50	milligrams per milliliter	1	MG
f1ee98a51b7a4521aae9781e2ebb8d3d	$13.02	$0.03	percent of total billed charges	Facility	Outpatient	$0.03	636		PEBTF ACO	500	milligram	1	MG
7ddf1ae9181f405faa904ea60e8d0434	$13.02	$0.03	percent of total billed charges	Facility	Outpatient	$0.03	636		PEBTF ACO	500	milligram	1	MG
303f1103a1b04773ba7b693ed946c81c	$14.71	$0.03	percent of total billed charges	Facility	Outpatient	$0.03	636		COMMERCIAL	500	milligram	1	MG
509e3c3251cf40d0bab15319dd91d9ec	$15.32	$0.31	percent of total billed charges	Facility	Outpatient	$0.03	636		COMMERCIAL	50	milligrams per milliliter	1	MG
fa4977c859c9437aac4eeb02ba2b0a96	$15.32	$0.03	percent of total billed charges	Facility	Outpatient	$0.03	636		COMMERCIAL	500	milligram	1	MG
8349fd15b3554837b157ee5d308e92a5	$15.32	$0.03	percent of total billed charges	Facility	Outpatient	$0.03	636		COMMERCIAL	500	milligram	1	MG
40b6c76ff12a4368bbd9a01dc055a471	$17.18	$0.34	percent of total billed charges	Facility	Outpatient	$0.03	636		ACO	50	milligrams per milliliter	1	MG
3d314d6f6be04ad892e46a05b220149f	$17.18	$0.03	percent of total billed charges	Facility	Outpatient	$0.03	636		ACO	500	milligram	1	MG
94e61335a589467c8e6794c65aba0ac0	$18.24	$0.36	percent of total billed charges	Facility	Outpatient	$0.03	636		PEBTF ACO	50	milligrams per milliliter	1	MG
2c5dcd94220f4470a6e2dafc95bbcb22	$18.24	$0.04	percent of total billed charges	Facility	Outpatient	$0.03	636		PEBTF ACO	500	milligram	1	MG
e38ed6e7569b485ea43294326a20ef98	$21.46	$0.43	percent of total billed charges	Facility	Outpatient	$0.03	636		COMMERCIAL	50	milligrams per milliliter	1	MG
62bc180d695b4151908afaf3813d25f3	$21.46	$0.04	percent of total billed charges	Facility	Outpatient	$0.03	636		COMMERCIAL	500	milligram	1	MG
0a80c2d97fe54e8ab3c5d01384db64b5	$29.46	$0.59	percent of total billed charges	Facility	Outpatient	$0.03	636		ACO	50	milligrams per milliliter	1	MG
85ed703d781342f8a9043ee1e49b9ec2	$29.46	$0.06	percent of total billed charges	Facility	Outpatient	$0.03	636		ACO	500	milligram	1	MG
f48a75c481574d92baf88bc09b92c0ec	$31.26	$0.63	percent of total billed charges	Facility	Outpatient	$0.03	636		PEBTF ACO	50	milligrams per milliliter	1	MG
c5bf0ba858384feaadb1fa62daae14a2	$31.26	$0.06	percent of total billed charges	Facility	Outpatient	$0.03	636		PEBTF ACO	500	milligram	1	MG
ca1137734f74411b8f6d8658f704e838	$36.78	$0.74	percent of total billed charges	Facility	Outpatient	$0.03	636		COMMERCIAL	50	milligrams per milliliter	1	MG
393dd9782b3846b3b6713788189414d3	$36.78	$0.07	percent of total billed charges	Facility	Outpatient	$0.03	636		COMMERCIAL	500	milligram	1	MG
05e0247a294d4500af4346f77a23c1f1	$49.10	$0.10	percent of total billed charges	Facility	Outpatient	$0.03	636		ACO	500	milligram	1	MG
477d25f883f749169293ffecb68155c5	$49.10	$0.10	percent of total billed charges	Facility	Outpatient	$0.03	636		ACO	500	milligram	1	MG
9b3d01a9a6fd4778bd21781caaa23edb	$51.56	$0.10	percent of total billed charges	Facility	Outpatient	$0.03	636		ACO	500	milligram	1	MG
8ecf5792cb814a119249bf6b40485f3c	$52.10	$0.10	percent of total billed charges	Facility	Outpatient	$0.03	636		PEBTF ACO	500	milligram	1	MG
632199541b3a4469b041be921948eeb2	$52.10	$0.10	percent of total billed charges	Facility	Outpatient	$0.03	636		PEBTF ACO	500	milligram	1	MG
89bcdee667094ba6bdbf1167b7ab9d2c	$54.70	$0.11	percent of total billed charges	Facility	Outpatient	$0.03	636		PEBTF ACO	500	milligram	1	MG
e2ba1044e52b4bf6957c161b4209a7af	$61.30	$0.12	percent of total billed charges	Facility	Outpatient	$0.03	636		COMMERCIAL	500	milligram	1	MG
24c809964fc0404f8d6340c523d36ec9	$61.30	$0.12	percent of total billed charges	Facility	Outpatient	$0.03	636		COMMERCIAL	500	milligram	1	MG
104369f9452040e1ad416878434b5f71	$61.38	$1.23	percent of total billed charges	Facility	Outpatient	$0.03	636		ACO	50	milligrams per milliliter	1	MG
e8a7f9c2ce0c47d2bcc3b5dcd0ee2ebb	$61.38	$0.12	percent of total billed charges	Facility	Outpatient	$0.03	636		ACO	500	milligram	1	MG
4b8eeb3136234378afc202fa069d952c	$64.36	$0.13	percent of total billed charges	Facility	Outpatient	$0.03	636		COMMERCIAL	500	milligram	1	MG
684f9104a5a44b918c74c16080535ab8	$65.13	$1.30	percent of total billed charges	Facility	Outpatient	$0.03	636		PEBTF ACO	50	milligrams per milliliter	1	MG
cb846585ebd54f2aa7514abc34f65db4	$65.13	$0.13	percent of total billed charges	Facility	Outpatient	$0.03	636		PEBTF ACO	500	milligram	1	MG
3a5f7f1f65b64bc8854f5bfe8e82b2f6	$76.63	$1.53	percent of total billed charges	Facility	Outpatient	$0.03	636		COMMERCIAL	50	milligrams per milliliter	1	MG
fac8b890c4fd495fa87554ddcbf61acb	$76.63	$0.15	percent of total billed charges	Facility	Outpatient	$0.03	636		COMMERCIAL	500	milligram	1	MG
01afbe48d2484c689cb8edbffb7f6129	$218.73	$4.37	percent of total billed charges	Facility	Outpatient	$0.03	636		ACO	50	milligrams per milliliter	1	MG
52da3d3b2e42473699fc3a960bb33d72	$218.73	$0.44	percent of total billed charges	Facility	Outpatient	$0.03	636		ACO	500	milligram	1	MG
7d81d967a301431c8c16e1f6b766150a	$218.73	$0.44	percent of total billed charges	Facility	Outpatient	$0.03	636		ACO	500	milligram	1	MG
4f4f71039b2c45dcb3ef9f8db777a890	$218.74	$4.37	percent of total billed charges	Facility	Outpatient	$0.03	636		ACO	50	milligrams per milliliter	1	MG
a25cc7fd26ef4704916f3f2a26daa619	$218.74	$0.44	percent of total billed charges	Facility	Outpatient	$0.03	636		ACO	500	milligram	1	MG
46904a30417f4468b506e59c6b53b841	$232.10	$4.64	percent of total billed charges	Facility	Outpatient	$0.03	636		PEBTF ACO	50	milligrams per milliliter	1	MG
bad555f139aa42e2b6a0146565e1449f	$232.10	$0.46	percent of total billed charges	Facility	Outpatient	$0.03	636		PEBTF ACO	500	milligram	1	MG
ceec8e485b94403089fcf2c4c7e4219b	$232.10	$4.64	percent of total billed charges	Facility	Outpatient	$0.03	636		PEBTF ACO	50	milligrams per milliliter	1	MG
f9b7c0e7e2354fe981b87f843779477a	$232.10	$0.46	percent of total billed charges	Facility	Outpatient	$0.03	636		PEBTF ACO	500	milligram	1	MG
28dd7336997746ccbd1318c10fa18b91	$232.10	$0.46	percent of total billed charges	Facility	Outpatient	$0.03	636		PEBTF ACO	500	milligram	1	MG
cce1c321797e4dcb8217cb737d40b5f7	$273.08	$5.46	percent of total billed charges	Facility	Outpatient	$0.03	636		COMMERCIAL	50	milligrams per milliliter	1	MG
6e59b9f34fde489183697dcd8f7328b0	$273.08	$0.55	percent of total billed charges	Facility	Outpatient	$0.03	636		COMMERCIAL	500	milligram	1	MG
15d755ba9e954ddea5b4a369950449ae	$273.08	$0.55	percent of total billed charges	Facility	Outpatient	$0.03	636		COMMERCIAL	500	milligram	1	MG
dc6d6604b30242b0b5a31bb7b4a7ca11	$273.09	$5.46	percent of total billed charges	Facility	Outpatient	$0.03	636		COMMERCIAL	50	milligrams per milliliter	1	MG
fb41bab1779d4967835c2f8b1aeb6516	$273.09	$0.55	percent of total billed charges	Facility	Outpatient	$0.03	636		COMMERCIAL	500	milligram	1	MG

---

Provider ID: 7846

Sample 41/55

Payer: 76 | Provider: Geisinger St Lukes Hospital | Code: J0490

Results:

• Number of rate records: 2
• Unique negotiated rates: 2
• ASP Payment Limit: $56.01
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $2051.85
• Max negotiated_dollar by contract_methodology:
  • percent of total billed charges: $3156.66
• Median dosage_std_dollar by payer_product_network:
  • Unsorted: $78.90
• Max dosage_std_dollar by contract_methodology:
  • percent of total billed charges: $78.90

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
f14d0676f5b440d893c5cd4d885b74d1	$947.04	$78.90	percent of total billed charges	Facility	Outpatient	$56.01	636		COMMERCIAL	120	milligram	10	MG
5c7ae1a95bd94cd28dfadaa1d5229e42	$3156.66	$78.90	percent of total billed charges	Facility	Outpatient	$56.01	636		COMMERCIAL	400	milligram	10	MG

---

Sample 42/55

Payer: 7 | Provider: Geisinger St Lukes Hospital | Code: J0897

Results:

• Number of rate records: 2
• Unique negotiated rates: 2
• ASP Payment Limit: $29.24
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $3289.32
• Max negotiated_dollar by contract_methodology:
  • percent of total billed charges: $3418.74
• Median dosage_std_dollar by payer_product_network:
  • Unsorted: $40.58
• Max dosage_std_dollar by contract_methodology:
  • percent of total billed charges: $52.67

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
2b509689047447b08ee74e22977616c2	$3159.90	$52.67	percent of total billed charges	Facility	Outpatient	$29.24	636		COMMERCIAL	60	milligrams per milliliter	1	MG
3dde369a793748bb879fb1370cd9a7ce	$3418.74	$28.49	percent of total billed charges	Facility	Outpatient	$29.24	636		COMMERCIAL	120	milligram	1	MG

---

Sample 43/55

Payer: 7 | Provider: Geisinger St Lukes Hospital | Code: J2248

Results:

• Number of rate records: 2
• Unique negotiated rates: 2
• ASP Payment Limit: $0.31
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $123.14
• Max negotiated_dollar by contract_methodology:
  • percent of total billed charges: $130.43
• Median dosage_std_dollar by payer_product_network:
  • Unsorted: $1.88
• Max dosage_std_dollar by contract_methodology:
  • percent of total billed charges: $2.61

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
c3b693c37da14976900ad282f40b6d3e	$115.85	$1.16	percent of total billed charges	Facility	Outpatient	$0.31	636		COMMERCIAL	100	milligram	1	MG
f484cf7b0c294bb4a0a2cba7335f8f92	$130.43	$2.61	percent of total billed charges	Facility	Outpatient	$0.31	636		COMMERCIAL	50	milligram	1	MG

---

Sample 44/55

Payer: 643 | Provider: Geisinger St Lukes Hospital | Code: J8501

Results:

• Number of rate records: 2
• Unique negotiated rates: 2
• ASP Payment Limit: $2.72
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $313.75
• Max negotiated_dollar by contract_methodology:
  • percent of total billed charges: $382.62
• Median dosage_std_dollar by payer_product_network:
  • Unsorted: $15.30
• Max dosage_std_dollar by contract_methodology:
  • percent of total billed charges: $15.30

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
ae0dc1fed53d476da2341d15389117d0	$244.87	$15.30	percent of total billed charges	Facility	Outpatient	$2.72	637		COMMERCIAL	80	milligram	5	MG
ed1f286c736c4f049a1820860c6bc2e6	$382.62	$15.30	percent of total billed charges	Facility	Outpatient	$2.72	637		COMMERCIAL	125	milligram	5	MG

---

Sample 45/55

Payer: 111 | Provider: Geisinger St Lukes Hospital | Code: J1944

Results:

• Number of rate records: 3
• Unique negotiated rates: 2
• ASP Payment Limit: $3.33
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $1090.05
• Max negotiated_dollar by contract_methodology:
  • percent of total billed charges: $1110.86
• Median dosage_std_dollar by payer_product_network:
  • Unsorted: $1.24
• Max dosage_std_dollar by contract_methodology:
  • percent of total billed charges: $2.47

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
608d19c79e694820887d172db5d07d4a	$1090.05	$2.47	percent of total billed charges	Facility	Outpatient	$3.33	636		COMMERCIAL	441	milligram	1	MG
3b32f6c825014eab800d58689c0ad335	$1090.05	$1.24	percent of total billed charges	Facility	Outpatient	$3.33	636		COMMERCIAL	882	milligram	1	MG
eb5d5104752c47eb90a140ad07907c65	$1110.86	$1.04	percent of total billed charges	Facility	Outpatient	$3.33	636		COMMERCIAL	1064	milligram	1	MG

---

Provider ID: 1116

Sample 46/55

Payer: 7 | Provider: Lehigh Valley Hospital – Muhlenberg | Code: J9200

Results:

• Number of rate records: 2
• Unique negotiated rates: 2
• ASP Payment Limit: $4125.55
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $19796.07
• Max negotiated_dollar by contract_methodology:
  • fee schedule: $22119.28

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
Error processing sample 46: unsupported format string passed to NoneType.format

Sample 47/55

Payer: 1150 | Provider: Lehigh Valley Hospital – Muhlenberg | Code: J0872

Results:

• Number of rate records: 2
• Unique negotiated rates: 2
• ASP Payment Limit: $0.05
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $0.06
• Max negotiated_dollar by contract_methodology:
  • fee schedule: $0.06

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
Error processing sample 47: unsupported format string passed to NoneType.format

Sample 48/55

Payer: 174 | Provider: Lehigh Valley Hospital – Muhlenberg | Code: J9048

Results:

• Number of rate records: 2
• Unique negotiated rates: 2
• ASP Payment Limit: $2.68
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $48.01
• Max negotiated_dollar by contract_methodology:
  • fee schedule: $53.34

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
Error processing sample 48: unsupported format string passed to NoneType.format

Sample 49/55

Payer: 643 | Provider: Lehigh Valley Hospital – Muhlenberg | Code: J3090

Results:

• Number of rate records: 2
• Unique negotiated rates: 2
• ASP Payment Limit: $1.91
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $5.42
• Max negotiated_dollar by contract_methodology:
  • fee schedule: $6.33

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
Error processing sample 49: unsupported format string passed to NoneType.format

Sample 50/55

Payer: 643 | Provider: Lehigh Valley Hospital – Muhlenberg | Code: J1557

Results:

• Number of rate records: 2
• Unique negotiated rates: 2
• ASP Payment Limit: $62.47
• Median negotiated_dollar by payer_product_network:
  • Unsorted: $171.19
• Max negotiated_dollar by contract_methodology:
  • fee schedule: $198.69

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
Error processing sample 50: unsupported format string passed to NoneType.format

Provider ID: 1086

Sample 51/55

Payer: 12 | Provider: Jefferson Stratford Hospital | Code: J1100

Results:

• Number of rate records: 5
• Unique negotiated rates: 3
• ASP Payment Limit: $0.12
• Median negotiated_dollar by payer_product_network:
• Max negotiated_dollar by contract_methodology:
  • case rate: $0.18
  • fee schedule: $0.14
• Median dosage_std_dollar by payer_product_network:
• Max dosage_std_dollar by contract_methodology:
  • case rate: $0.18
  • fee schedule: $0.14

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
a85bf64a82384c15a56c442ef2d12604	$0.11	$0.11	case rate	Facility	Outpatient	$0.12			COMMERCIAL	1	milligram	1	MG
8de4f8a22bd7443294b2dd21696316c1	$0.11	$0.11	case rate	Facility	Outpatient	$0.12			JNJ001_JNJ002_JNJ003 COMMERCIAL	1	milligram	1	MG
54c511aec8bc4400a12a27254b8af5c2	$0.14	$0.14	fee schedule	Facility	Outpatient	$0.12			ADMIN_INDEMNITY	1	milligram	1	MG
c103a3e7799e45ce8fac9ec3570406f0	$0.14	$0.14	case rate	Facility	Outpatient	$0.12			JNJ001_JNJ002_JNJ003 COMMERCIAL	1	milligram	1	MG
15c0935be59e42a2b453f58a6144cab9	$0.18	$0.18	case rate	Facility	Outpatient	$0.12			JNJ001_JNJ002_JNJ003 COMMERCIAL	1	milligram	1	MG

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Sample 52/55

Payer: 12 | Provider: Jefferson Stratford Hospital | Code: J0577

Results:

• Number of rate records: 4
• Unique negotiated rates: 4
• ASP Payment Limit: $422.83
• Median negotiated_dollar by payer_product_network:
• Max negotiated_dollar by contract_methodology:
  • case rate: $686.65

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
Error processing sample 52: unsupported format string passed to NoneType.format

Sample 53/55

Payer: 7 | Provider: Jefferson Stratford Hospital | Code: J9319

Results:

• Number of rate records: 2
• Unique negotiated rates: 2
• ASP Payment Limit: $31.07
• Median negotiated_dollar by payer_product_network:
• Max negotiated_dollar by contract_methodology:
  • case rate: $38.82
  • fee schedule: $51.36
• Median dosage_std_dollar by payer_product_network:
• Max dosage_std_dollar by contract_methodology:
  • case rate: $38.82
  • fee schedule: $51.36

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
f6756591174c4aa79f3dc19fb6136bec	$38.82	$38.82	case rate	Facility	Outpatient	$31.07			JNJ001_JNJ002_JNJ003 COMMERCIAL	0.1	milligram	0.1	MG
d1efc648fc1b44468db58232ce4affeb	$51.36	$51.36	fee schedule	Facility	Outpatient	$31.07			COMMERCIAL	0.1	milligram	0.1	MG

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Sample 54/55

Payer: 12 | Provider: Jefferson Stratford Hospital | Code: J2403

Results:

• Number of rate records: 5
• Unique negotiated rates: 5
• ASP Payment Limit: $0.60
• Median negotiated_dollar by payer_product_network:
• Max negotiated_dollar by contract_methodology:
  • case rate: $1.00
  • fee schedule: $0.70
• Median dosage_std_dollar by payer_product_network:
• Max dosage_std_dollar by contract_methodology:
  • case rate: $1.00
  • fee schedule: $0.70

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
8bc076c2ee974688a95434ad5bda1dd7	$0.63	$0.63	case rate	Facility	Outpatient	$0.60			COMMERCIAL	1	milligram	1	MG
c0205140cfd749d5a05a7e606cb1b49d	$0.64	$0.64	case rate	Facility	Outpatient	$0.60			JNJ001_JNJ002_JNJ003 COMMERCIAL	1	milligram	1	MG
5d7f8abba9e24443a2741dcadc341a8b	$0.70	$0.70	fee schedule	Facility	Outpatient	$0.60			ADMIN_INDEMNITY	1	milligram	1	MG
f78fdbee118941b2ac1ae4378c3f3b44	$0.79	$0.79	case rate	Facility	Outpatient	$0.60			JNJ001_JNJ002_JNJ003 COMMERCIAL	1	milligram	1	MG
9a62642e4da246df9bc94d80d026eede	$1.00	$1.00	case rate	Facility	Outpatient	$0.60			JNJ001_JNJ002_JNJ003 COMMERCIAL	1	milligram	1	MG

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Sample 55/55

Payer: 7 | Provider: Jefferson Stratford Hospital | Code: J0694

Results:

• Number of rate records: 2
• Unique negotiated rates: 2
• ASP Payment Limit: $5.13
• Median negotiated_dollar by payer_product_network:
• Max negotiated_dollar by contract_methodology:
  • case rate: $5.86
  • fee schedule: $7.76
• Median dosage_std_dollar by payer_product_network:
• Max dosage_std_dollar by contract_methodology:
  • case rate: $5.86
  • fee schedule: $7.76

Detailed Rates:

ID	Rate	Dosage Std Rate	Contract Methodology	Billing Class	Setting	ASP Limit	Revenue Code	Modifier	Plan Name	Parsed Quantity	Parsed Unit Label	ASP Quantity	ASP Unit Label
cc13292661d74eabbbb5472aa6cfac6b	$5.86	$5.86	case rate	Facility	Outpatient	$5.13			JNJ001_JNJ002_JNJ003 COMMERCIAL	1	gram	1	GM
43ac39ea1df548f1b31135755f30c769	$7.76	$7.76	fee schedule	Facility	Outpatient	$5.13			COMMERCIAL	1	gram	1	GM

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