{ "hospital_name": "Coshocton Regional Medical Center", "last_updated_on": "2026-03-17", "version": "3.0", "location_name": [ "Coshocton Regional Medical Center" ], "hospital_address": [ "1460 Orange Street Coshocton, OH 43812" ], "license_information": { "license_number": "320506896", "state": "OH" }, "attestation": { "attestation": "To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.", "confirm_attestation": true, "attester_name": "Stephanie Conn" }, "type_2_npi": [ "1013468172" ], "standard_charge_information": [ { "description": "17-KETOSTEROIDS TOTAL", "code_information": [ { "code": "83586", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 47.0, "discounted_cash": 12.0, "minimum": 12.8, "maximum": 46.06, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.16, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.83 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.16, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.16, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.54 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.16, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.16, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.16, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.16, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.7, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.16, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "17-HYDROXYPREGNENOLONE", "code_information": [ { "code": "84143", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82.0, "discounted_cash": 22.0, "minimum": 22.81, "maximum": 80.36, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 34.15, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.83 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 23.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.07, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 34.15, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 23.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 31.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 34.15, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.07, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.54 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 34.15, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 25.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 34.15, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 34.15, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 34.15, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 24.41, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.15, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "24 HR CALCIUM QT", "code_information": [ { "code": "82340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 179.81, "discounted_cash": 6.0, "minimum": 6.03, "maximum": 176.2138, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.54, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.45, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "17-OH PROGESTERONE LC/MS070085", "code_information": [ { "code": "83498", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50.0, "discounted_cash": 27.0, "minimum": 15.0, "maximum": 290.1584, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.83 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 27.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 38.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 45.5, "10th_percentile": 45.5, "90th_percentile": 45.5, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.54 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 29.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 29.07, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.67, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "24HR CATECHOLAMINES FRAC", "code_information": [ { "code": "82384", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 239.9, "discounted_cash": 25.0, "minimum": 25.25, "maximum": 235.102, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 26.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 35.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 92.64, "10th_percentile": 92.64, "90th_percentile": 92.64, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 27.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.8, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "2D TTE W OR W/O FOL W/CON,CO", "code_information": [ { "code": "93307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 691.68, "discounted_cash": 224.0, "minimum": 46.2, "maximum": 2548.0, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 336.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 280.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 231.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 325.7, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 336.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 235.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 314.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 336.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 229.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 325.7, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 336.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 247.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 336.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 336.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 465.03 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 224.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 336.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 224.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 224.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 240.34, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 336.26, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "2.7 CORT SELF TAPNG SCREW 24MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "24HR URINE PHOSPHORUS", "code_information": [ { "code": "84105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19.0, "discounted_cash": 5.0, "minimum": 5.7, "maximum": 18.62, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.38, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.9, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.38, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.18, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "2ND CLOS-SURG WND/DEH EXT/COMP", "code_information": [ { "code": "13160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4646.88, "discounted_cash": 3336.0, "minimum": 736.4883, "maximum": 4646.88, "payers_information": [ { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3503.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 3436.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4646.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 736.49 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3336.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4646.88, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3503.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 4646.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4646.88, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3402.92, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4646.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 751.22 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3336.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4646.88, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 773.31 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3669.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4646.88, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4646.88, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 773.31 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 736.49 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3336.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4646.88, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 736.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3336.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3336.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 3336.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 773.31 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3336.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3569.73, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4646.88, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4646.88, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 773.31 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 758.58 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3336.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4170.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 736.49 } ] } ] }, { "description": "24 HR IODINE", "code_information": [ { "code": "83789", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 387.0, "discounted_cash": 24.0, "minimum": 18.6, "maximum": 379.26, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.09, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 24.83, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.09, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 33.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.09, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.59, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.09, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 26.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.09, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.09, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.09, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.09, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "2D TEE W OR W/O FOL W/CON,IN", "code_information": [ { "code": "C8925", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3950.3, "discounted_cash": 738.0, "minimum": 465.0257, "maximum": 3871.294, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1104.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 488.28 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 478.98 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 738.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 922.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 465.03 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 774.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 760.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1070.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 465.03 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 738.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1104.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 774.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 1033.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1104.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 752.77, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1070.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 474.33 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 738.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1104.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 488.28 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 811.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1104.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1104.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 488.28 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 465.03 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 738.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1104.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 465.03 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 738.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 738.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 738.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 488.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 738.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 789.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1104.8, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "2.7 CORT SELF TAPNG SCREW 20MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "3D CORONARY POST PROCESS/CARDI", "code_information": [ { "code": "75572", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 605.22, "discounted_cash": 328.0, "minimum": 181.566, "maximum": 593.1156, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 544.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 533.73 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 410.55, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 518.18 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 338.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 476.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 518.18 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 344.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 459.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 335.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 476.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 528.54 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 544.09 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 361.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 544.09 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 518.18 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 518.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 544.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 328.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 351.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 491.67, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "36115853", "code_information": [ { "code": "97597", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 873.65, "discounted_cash": 188.0, "minimum": 152.055, "maximum": 856.177, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 236.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 198.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 194.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 273.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 198.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 264.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 273.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 207.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 245.11 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 202.1, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "2D TTE W OR W/O FOL W/CON,FU", "code_information": [ { "code": "93308", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1613.92, "discounted_cash": 224.0, "minimum": 12.705, "maximum": 1581.6416, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 336.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 280.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 231.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 325.7, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 336.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 235.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 314.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 336.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 229.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 325.7, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 336.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 247.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 336.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 336.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 465.03 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 224.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 336.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 224.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 224.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 240.34, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 336.26, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "2.7 CORT SELF TAPNG SCREW 22MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "4.0 CANCE PARTIAL THREED SCREW - C1713 - 27801591", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "AB ID;PLT ASS'D IMMUNO ASSAY", "code_information": [ { "code": "86023", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 436.0, "discounted_cash": 12.0, "minimum": 12.46, "maximum": 427.28, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.83, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.07, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 17.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.07, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 12.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.33, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.65, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "4.0 CANCE PARTIAL THREED SCREW - C1713 - 27801590", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "24 CATECHOLAMINES FRAC", "code_information": [ { "code": "82384", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 91.0, "discounted_cash": 25.0, "minimum": 25.25, "maximum": 235.102, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 26.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 35.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 92.64, "10th_percentile": 92.64, "90th_percentile": 92.64, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 27.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.8, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "4.0 CANCELLOUS PARTIAL THRED", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "ABD PARACENTESIS WITH GUIDANCE", "code_information": [ { "code": "49083", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3807.75, "discounted_cash": 853.0, "minimum": 669.141, "maximum": 3731.595, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1278.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2282.96 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2239.48 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 853.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1067.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2174.25 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 896.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 879.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1238.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2174.25 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 853.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1278.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 896.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 1195.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1278.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 870.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1238.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2217.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 853.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1278.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2282.96 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 939.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1278.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1278.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 2282.96 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2174.25 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 853.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1278.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2174.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 853.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 853.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 853.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2282.96 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 853.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 913.64, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1278.24, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "24 HR PORPHOBILINOGEN QT", "code_information": [ { "code": "84110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31.0, "discounted_cash": 8.0, "minimum": 8.44, "maximum": 30.38, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.55, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 9.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.63, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "AB IDENTIFICATION;PLATELET AB", "code_information": [ { "code": "86022", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 370.5, "discounted_cash": 18.0, "minimum": 18.37, "maximum": 363.09, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.64, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 25.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.74, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.64, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 20.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.66, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.5, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ABDOMINAL PAIN - SOI : 3", "code_information": [ { "code": "2513", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7315.06, "maximum": 8399.77, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 8399.77 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8239.77 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7999.78 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 7999.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8159.77 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 8399.77 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 7315.06 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7999.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8399.77 } ] } ] }, { "description": "AB, BACTERIA OTHER", "code_information": [ { "code": "86609", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 47.0, "discounted_cash": 12.0, "minimum": 12.88, "maximum": 46.06, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.28, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.28, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.28, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.28, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.28, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.28, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.28, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.78, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.28, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ABDOMINAL PAIN - SOI : 1", "code_information": [ { "code": "2511", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4283.88, "maximum": 4904.97, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 4904.97 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4811.54 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4671.4 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 4671.4 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4764.83 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 4904.97 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 4283.88 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4671.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4904.97 } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [ { "code": "770", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7778.0, "minimum": 7283.36, "maximum": 15945.5355, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9419.53, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7778.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9722.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8167.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 8011.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 11278.55, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 7778.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9419.53, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8167.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 10111.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9419.53, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 7933.88, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11278.55, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7778.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9419.53, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 12445.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8556.14, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9419.53, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9419.53, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 14389.87, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 15945.54, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7778.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9419.53, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7778.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7283.36 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 7778.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7778.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 8322.79, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9419.53, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY- SOI : 1", "code_information": [ { "code": "5431", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3498.14, "maximum": 3999.05, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 3999.05 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3922.88 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3808.62 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 3808.62 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3884.79 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 3999.05 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 3498.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3808.62 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3999.05 } ] } ] }, { "description": "3.5 CORTEX SELF TAPPING SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "ABDOMINAL PAIN - SOI : 4", "code_information": [ { "code": "2514", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7315.06, "maximum": 8399.77, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 8399.77 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8239.77 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7999.78 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 7999.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8159.77 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 8399.77 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 7315.06 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7999.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8399.77 } ] } ] }, { "description": "ABORTION WITHOUT D&C", "code_information": [ { "code": "779", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6684.0, "minimum": 3913.87, "maximum": 13703.43, "payers_information": [ { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 6818.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9692.67, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6684.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8095.05, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 10695.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7353.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8095.05, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8095.05, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 12366.51, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 13703.43, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6684.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8095.05, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6684.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3913.87 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 6684.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6684.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 7152.52, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8095.05, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8095.05, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6684.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8355.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7018.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 6885.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 9692.67, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 6684.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8095.05, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7018.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 8689.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8095.05, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY- SOI : 4", "code_information": [ { "code": "5434", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10066.33, "maximum": 11571.86, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 11571.86 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 11351.44 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 11020.82 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 11020.82 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 11241.23 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 11571.86 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 10066.33 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11020.82 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11571.86 } ] } ] }, { "description": "4.0 CANCE PARTIAL THREED SCREW - C1713 - 27801589", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "ABG", "code_information": [ { "code": "82805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 665.52, "discounted_cash": 78.0, "minimum": 48.55, "maximum": 652.2096, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 117.92, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.98 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 501.14, "10th_percentile": 501.14, "90th_percentile": 501.14, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.01 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 98.46, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.55 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 81.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.22, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.55 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 117.92, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 82.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 110.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 117.92, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.22, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.52 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 117.92, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.98 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 86.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 117.92, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 117.92, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 50.98 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 48.55 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 117.92, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 84.28, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 117.92, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ABORTION WO D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY - SOI : 3", "code_information": [ { "code": "5643", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7096.14, "maximum": 8147.37, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 8147.37 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7992.18 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7759.4 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 7759.4 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7914.59 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 8147.37 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 7096.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7759.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8147.37 } ] } ] }, { "description": "9VHPV VACCINE 3 DOSE IM", "code_information": [ { "code": "90651", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 288.75, "minimum": 22.1765, "maximum": 282.975, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.85 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.18 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.18 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.62 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.29 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 23.29 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.29 } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY- SOI : 2", "code_information": [ { "code": "5432", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4467.61, "maximum": 5116.81, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 5116.81 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5019.34 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4873.15 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 4873.15 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4970.61 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 5116.81 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 4467.61 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4873.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5116.81 } ] } ] }, { "description": "ABD PARACENTESIS W/IMAGING", "code_information": [ { "code": "49083", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2230.47, "discounted_cash": 853.0, "minimum": 669.141, "maximum": 3731.595, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1278.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 853.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1067.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 896.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 879.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1238.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 853.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1278.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 896.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 1195.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1278.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 870.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1238.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 853.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1278.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 939.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1278.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1278.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2174.25 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 853.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1278.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 853.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 853.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 853.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 853.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 913.64, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1278.24, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ABORTION WO D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY - SOI : 2", "code_information": [ { "code": "5642", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3781.17, "maximum": 4325.36, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 4325.36 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4242.97 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4119.39 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 4119.39 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4201.78 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 4325.36 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 3781.17 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4119.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4325.36 } ] } ] }, { "description": "ACCUTECH/MED", "code_information": [ { "code": "A4641", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 823.9, "minimum": 26.565, "maximum": 807.422, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 170.43 } ] } ] }, { "description": "ABDOMINAL PAIN - SOI : 2", "code_information": [ { "code": "2512", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5256.49, "maximum": 6026.34, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 6026.34 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5911.55 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5739.37 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 5739.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5854.15 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 6026.34 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 5256.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5739.37 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6026.34 } ] } ] }, { "description": "ACCUTECH/MN RP (NM RADIOPHARM)", "code_information": [ { "code": "A4641", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 585.2, "minimum": 26.565, "maximum": 807.422, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 170.43 } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY- SOI : 3", "code_information": [ { "code": "5433", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5630.98, "maximum": 6458.11, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 6458.11 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6335.1 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6150.59 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 6150.59 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6273.6 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 6458.11 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 5630.98 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6150.59 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6458.11 } ] } ] }, { "description": "ACETAMINOPHEN DRUG ASSAY LC", "code_information": [ { "code": "80143", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30.0, "discounted_cash": 18.0, "minimum": 9.0, "maximum": 29.4, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.9, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.31 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.82 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.3, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.1 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 19.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.03, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.1 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.9, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 26.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.9, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.03, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.58 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.9, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.31 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 20.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.9, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.9, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.31 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.1 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.9, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.31 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.94, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.9, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ACETONE, QL", "code_information": [ { "code": "82009", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 108.07, "discounted_cash": 4.0, "minimum": 4.52, "maximum": 105.9086, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6.77, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.55, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6.77, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6.77, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.55, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6.77, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4.97, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6.77, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6.77, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6.77, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.84, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.77, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ACETAMINOPHEN", "code_information": [ { "code": "80329", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 57.0, "minimum": 7.8, "maximum": 55.86, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.63 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 62.5, "10th_percentile": 62.5, "90th_percentile": 62.5, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.84 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 75.53, "10th_percentile": 75.53, "90th_percentile": 75.53, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.44 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.63 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 41.63 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 66.73, "10th_percentile": 66.73, "90th_percentile": 66.73, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.63 } ] } ] }, { "description": "ABORTION WO D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY - SOI : 1", "code_information": [ { "code": "5641", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3001.68, "maximum": 3426.65, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 3426.65 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3361.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3263.47 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 3263.47 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3328.74 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 3426.65 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 3001.68 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3263.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3426.65 } ] } ] }, { "description": "ACETONE/KETONES. QT", "code_information": [ { "code": "82010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28.0, "discounted_cash": 8.0, "minimum": 8.17, "maximum": 27.44, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.23, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.23, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.23, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.33, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.23, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 8.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.23, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.23, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.23, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.23, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ACHR BINDING ANTIBODY", "code_information": [ { "code": "86041", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 144.4, "discounted_cash": 18.0, "minimum": 18.4, "maximum": 141.512, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.68, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.68, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.69, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.54, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ACID PHOSPHATASE, PROSTATIC", "code_information": [ { "code": "84066", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35.0, "discounted_cash": 9.0, "minimum": 9.66, "maximum": 34.3, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.01, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.85, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.01, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.34, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ABORTION WO D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY - SOI : 4", "code_information": [ { "code": "5644", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7096.14, "maximum": 8147.37, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 8147.37 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7992.18 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7759.4 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 7759.4 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7914.59 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 8147.37 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 7096.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7759.4 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8147.37 } ] } ] }, { "description": "ACETYLCHOLINESTERASE", "code_information": [ { "code": "82013", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.0, "discounted_cash": 12.0, "minimum": 12.0, "maximum": 39.2, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.36, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.54, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.15, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ACID PHOSPHATASE TOTAL", "code_information": [ { "code": "84060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27.0, "discounted_cash": 7.0, "minimum": 7.64, "maximum": 26.46, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.08, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 10.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.08, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ACT PROTEIN C (APC)RESISTANCE", "code_information": [ { "code": "85307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 232.0, "discounted_cash": 15.0, "minimum": 11.1757, "maximum": 227.36, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.74 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.52 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.18 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.21, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.18 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 21.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.21, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.4 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.74 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 11.74 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 11.18 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.39, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.93, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ACTH-ADRENOCORT HORMONE", "code_information": [ { "code": "82024", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 360.14, "discounted_cash": 38.0, "minimum": 36.44, "maximum": 352.9372, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.26 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.53 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.44 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 39.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 56.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.44 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 77.66, "10th_percentile": 77.66, "90th_percentile": 77.66, "count": "1 through 10" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 54.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 327.73, "10th_percentile": 327.73, "90th_percentile": 327.73, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 56.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.17 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.26 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 42.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 54.0, "median_amount": 194.48, "10th_percentile": 194.48, "90th_percentile": 194.48, "count": "1 through 10" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 38.26 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 36.44 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.26 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 41.32, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 57.81, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ACTH STIMULATION PANEL", "code_information": [ { "code": "80400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.0, "discounted_cash": 32.0, "minimum": 32.62, "maximum": 108.78, "payers_information": [ { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.44 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 33.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.3, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.44 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 48.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 34.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 45.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 48.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.3, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.17 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 48.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.26 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 35.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 48.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 48.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 38.26 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 36.44 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 48.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.26 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 34.9, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 48.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.26 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.53 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.78, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "ACETADOTE 200 MG/ML INJECTION", "drug_information": { "unit": 30.0, "type": "ML" }, "code_information": [ { "code": "00574080530", "type": "NDC" }, { "code": "J0132", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 414.08, "10th_percentile": 414.08, "90th_percentile": 828.15, "count": "1 through 10" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 500.41, "10th_percentile": 500.41, "90th_percentile": 1501.23, "count": "1 through 10" } ] } ] }, { "description": "ACTINOMYCES AB", "code_information": [ { "code": "86602", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.0, "discounted_cash": 10.0, "minimum": 10.18, "maximum": 36.26, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.89, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.24, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ACUTE & SUBACUTE ENDOCARDITIS - SOI : 4", "code_information": [ { "code": "1934", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13818.36, "maximum": 15897.76, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 15897.76 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 15594.95 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 15140.72 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 15140.72 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 15443.54 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 15897.76 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 13818.36 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15140.72 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15897.76 } ] } ] }, { "description": "ACTIN ANTIBODY (ASMA)", "code_information": [ { "code": "86015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.45, "discounted_cash": 12.0, "minimum": 7.935, "maximum": 26.45, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.45 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.45 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.45 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.45 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.45 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.45 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 26.45 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 26.45 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.45 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ACHR BLOCKING ANTIBODY", "code_information": [ { "code": "86042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 144.4, "discounted_cash": 18.0, "minimum": 18.4, "maximum": 141.512, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.68, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.68, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.69, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.54, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ACUTE & SUBACUTE ENDOCARDITIS - SOI : 1", "code_information": [ { "code": "1931", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6431.59, "maximum": 7381.17, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 7381.17 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7240.57 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7029.68 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 7029.68 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7170.28 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 7381.17 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 6431.59 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7029.68 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7381.17 } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CCMCC", "code_information": [ { "code": "290", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7283.0, "minimum": 7283.63, "maximum": 15750.0, "payers_information": [ { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 7429.3, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10561.26, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7283.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8820.48, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 11653.81, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8011.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8820.48, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8820.48, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 13474.72, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 14931.44, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7283.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8820.48, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7283.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9272.3 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 7283.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7283.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 7793.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8820.48, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8820.48, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7283.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9104.54, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7647.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 7502.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 10561.26, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 7283.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8820.48, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7647.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 9468.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8820.48, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ACTIVASE 2 MG CATHFLO", "drug_information": { "unit": 2.0, "type": "ME" }, "code_information": [ { "code": "50242004164", "type": "NDC" }, { "code": "J2997", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 93.0, "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 210.58, "10th_percentile": 210.58, "90th_percentile": 210.58, "count": "1 through 10" } ] } ] }, { "description": "ACHR MODULATING ANTIBODY", "code_information": [ { "code": "86043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 144.45, "discounted_cash": 12.0, "minimum": 12.05, "maximum": 141.561, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION", "code_information": [ { "code": "880", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7490.0, "minimum": 5605.01, "maximum": 15355.1355, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9070.77, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7490.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9362.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7864.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 7715.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 10860.95, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 7490.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9070.77, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7864.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 9737.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9070.77, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 7640.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10860.95, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7490.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9070.77, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 11984.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8239.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9070.77, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9070.77, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 13857.07, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 15355.14, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7490.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9070.77, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7490.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5605.01 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 7490.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7490.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 8014.63, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9070.77, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ACUTE HEPATITIS PANEL", "code_information": [ { "code": "80074", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 563.0, "discounted_cash": 47.0, "minimum": 25.8888, "maximum": 551.74, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 71.3, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.18 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 23.52, "10th_percentile": 23.52, "90th_percentile": 23.52, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.67 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.54, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 49.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 69.06, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 71.3, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 50.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 66.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 71.3, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.58, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 69.06, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.41 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 71.3, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.18 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 52.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 71.3, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 71.3, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 54.0, "median_amount": 141.6, "10th_percentile": 141.6, "90th_percentile": 141.6, "count": "1 through 10" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 27.18 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 25.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 71.3, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 50.96, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 71.3, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ACUTE & SUBACUTE ENDOCARDITIS - SOI : 2", "code_information": [ { "code": "1932", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6537.13, "maximum": 7502.86, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 7502.86 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7359.95 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7145.58 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 7145.58 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7288.49 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 7502.86 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 6537.13 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7145.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7502.86 } ] } ] }, { "description": "ACOUSTIC REFLEX", "code_information": [ { "code": "92568", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 96.36, "discounted_cash": 35.0, "minimum": 28.908, "maximum": 94.4328, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.28 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.23 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.65 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 36.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.98, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.65 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 36.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 49.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.98, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.7 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.28 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 38.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 55.28 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 52.65 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 35.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.62, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.63, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ACUTE ANXIETY & DELIRIUM STATES - SOI : 3", "code_information": [ { "code": "7563", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8157.87, "maximum": 10732.64, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 10732.64 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 10528.21 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 10221.56 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 10221.56 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 10425.99 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 10732.64 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 8157.87 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10221.56 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10732.64 } ] } ] }, { "description": "ACUTE LEUKEMIA - SOI : 1", "code_information": [ { "code": "6901", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22703.9, "maximum": 26142.37, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 26142.37 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 25644.42 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 24897.5 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 24897.5 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 25395.45 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 26142.37 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 22703.9 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 24897.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 26142.37 } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH CC", "code_information": [ { "code": "289", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12550.0, "minimum": 6570.89, "maximum": 25727.951, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15198.32, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12550.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15687.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13177.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 12926.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 18197.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 12550.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15198.32, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13177.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 16315.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15198.32, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 12801.2, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 18197.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 12550.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15198.32, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 20080.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 13805.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15198.32, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15198.32, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 23217.91, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 25727.95, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12550.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15198.32, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12550.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6570.89 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 12550.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12550.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 13428.74, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15198.32, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ACUTE & SUBACUTE ENDOCARDITIS - SOI : 3", "code_information": [ { "code": "1933", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8844.33, "maximum": 10162.94, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 10162.94 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 9969.36 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9678.99 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 9678.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9872.57 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 10162.94 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 8844.33 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9678.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10162.94 } ] } ] }, { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS - SOI : 4", "code_information": [ { "code": "1454", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12809.0, "maximum": 14734.03, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 14734.03 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 14453.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 14032.41 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 14032.41 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 14313.06 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 14734.03 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 12809.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14032.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14734.03 } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITH CCMCC", "code_information": [ { "code": "121", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8866.0, "minimum": 4119.51, "maximum": 18450.0, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10737.44, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8866.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11083.24, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9309.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 9132.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 12856.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 8866.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10737.44, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9309.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 11526.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10737.44, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 9043.92, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12856.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8866.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10737.44, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 14186.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9753.25, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10737.44, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10737.44, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 16403.19, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 18176.51, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8866.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10737.44, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8866.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4119.51 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 8866.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8866.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 9487.25, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10737.44, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ACUTE ANXIETY & DELIRIUM STATES - SOI : 1", "code_information": [ { "code": "7561", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6391.71, "maximum": 8380.84, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 8380.84 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8221.2 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7981.75 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 7981.75 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8141.39 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 8380.84 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 6391.71 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7981.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8380.84 } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC", "code_information": [ { "code": "288", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19321.0, "minimum": 19321.8, "maximum": 39609.772, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 23398.75, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 19321.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 24152.3, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20287.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 19901.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 28016.67, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 19321.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 23398.75, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20287.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 25118.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 23398.75, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 19708.24, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 28016.67, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 19321.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 23398.75, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 30914.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 21253.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 23398.75, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 23398.75, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 35745.4, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 39609.77, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19321.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 23398.75, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19321.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25512.3 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 19321.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19321.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 20674.37, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23398.75, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ACUTE KIDNEY INJURY - SOI : 2", "code_information": [ { "code": "4692", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4973.46, "maximum": 5700.02, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 5700.02 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5591.45 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5428.59 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 5428.59 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5537.16 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 5700.02 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 4973.46 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5428.59 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5700.02 } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITHOUT CCMCC", "code_information": [ { "code": "122", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6308.0, "minimum": 2641.67, "maximum": 12932.4455, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7639.61, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7885.64, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6623.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 6497.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 9147.34, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 6308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7639.61, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6623.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 8201.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7639.61, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 6434.68, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9147.34, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7639.61, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 10093.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6939.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7639.61, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7639.61, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 11670.74, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 12932.45, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7639.61, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 2641.67 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 6308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6308.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 6750.11, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7639.61, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS - SOI : 1", "code_information": [ { "code": "1451", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3972.72, "maximum": 4546.21, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 4546.21 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4459.61 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4329.72 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 4329.72 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4416.32 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 4546.21 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 3972.72 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4329.72 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4546.21 } ] } ] }, { "description": "ACUTE ANXIETY & DELIRIUM STATES - SOI : 2", "code_information": [ { "code": "7562", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7260.33, "maximum": 9537.36, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 9537.36 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 9355.69 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9083.2 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 9083.2 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9264.86 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 9537.36 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 7260.33 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9083.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9537.36 } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "836", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9247.0, "minimum": 9247.42, "maximum": 18957.211, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11198.63, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9247.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11559.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9709.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 9524.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 13408.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 9247.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11198.63, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9709.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 12021.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11198.63, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 9432.37, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13408.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9247.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11198.63, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 14795.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 10172.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11198.63, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11198.63, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 17107.73, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 18957.21, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9247.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11198.63, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9247.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12035.1 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 9247.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9247.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 9894.74, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11198.63, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION - SOI : 1", "code_information": [ { "code": "1901", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4666.2, "maximum": 5345.77, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 5345.77 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5243.94 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5091.21 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 5091.21 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5193.03 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 5345.77 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 4666.2 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5091.21 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5345.77 } ] } ] }, { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS - SOI : 3", "code_information": [ { "code": "1453", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7236.87, "maximum": 8309.63, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 8309.63 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8151.35 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7913.93 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 7913.93 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8072.21 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 8309.63 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 7236.87 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7913.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8309.63 } ] } ] }, { "description": "ACUTE ANXIETY & DELIRIUM STATES - SOI : 4", "code_information": [ { "code": "7564", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10350.92, "maximum": 13654.13, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 13654.13 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 13394.05 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 13003.94 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 13003.94 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 13264.01 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 13654.13 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 10350.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13003.94 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13654.13 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION - SOI : 2", "code_information": [ { "code": "1902", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5660.7, "maximum": 6492.37, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 6492.37 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6368.7 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6183.21 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 6183.21 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6306.87 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 6492.37 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 5660.7 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6183.21 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6492.37 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION - SOI : 3", "code_information": [ { "code": "1903", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7192.31, "maximum": 8258.25, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 8258.25 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8100.95 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7865.0 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 7865.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8022.3 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 8258.25 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 7192.31 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7865.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8258.25 } ] } ] }, { "description": "ACUTE KIDNEY INJURY - SOI : 3", "code_information": [ { "code": "4693", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8293.91, "maximum": 9528.34, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 9528.34 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 9346.85 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9074.61 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 9074.61 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9256.11 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 9528.34 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 8293.91 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9074.61 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9528.34 } ] } ] }, { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS - SOI : 2", "code_information": [ { "code": "1452", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4757.68, "maximum": 5451.23, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 5451.23 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5347.4 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5191.65 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 5191.65 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5295.48 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 5451.23 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 4757.68 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5191.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5451.23 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CCMCC", "code_information": [ { "code": "282", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5883.0, "minimum": 5883.64, "maximum": 12061.462, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7125.09, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5883.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7354.55, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6177.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 6060.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 8531.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 5883.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7125.09, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6177.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 7648.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7125.09, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 6001.31, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8531.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 5883.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7125.09, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 9413.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6472.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7125.09, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7125.09, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 10884.73, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 12061.46, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5883.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7125.09, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5883.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7860.16 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 5883.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5883.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 6295.49, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7125.09, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION - SOI : 4", "code_information": [ { "code": "1904", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11210.93, "maximum": 12891.53, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 12891.53 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 12645.98 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12277.65 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 12277.65 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12523.2 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 12891.53 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 11210.93 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12277.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12891.53 } ] } ] }, { "description": "ACUTE KIDNEY INJURY - SOI : 4", "code_information": [ { "code": "4694", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15516.5, "maximum": 17855.64, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 17855.64 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 17515.53 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 17005.37 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 17005.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 17345.48 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 17855.64 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 15516.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17005.37 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 17855.64 } ] } ] }, { "description": "ACUTE KIDNEY INJURY - SOI : 1", "code_information": [ { "code": "4691", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3811.66, "maximum": 4360.52, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 4360.52 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4277.46 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4152.87 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 4152.87 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4235.93 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 4360.52 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 3811.66 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4152.87 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4360.52 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC", "code_information": [ { "code": "284", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5674.0, "minimum": 5674.25, "maximum": 11632.2125, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6871.52, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5674.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7092.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5957.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 5844.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 8227.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 5674.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6871.52, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5957.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 7376.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6871.52, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 5787.74, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8227.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 5674.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6871.52, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 9078.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6241.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6871.52, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6871.52, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 10497.36, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 11632.21, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5674.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6871.52, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5674.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7018.0 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 5674.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5674.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 6071.45, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6871.52, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC", "code_information": [ { "code": "281", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7211.0, "minimum": 7211.8, "maximum": 14784.19, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8733.49, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7211.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9014.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7572.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 7428.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 10457.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 7211.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8733.49, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7572.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 9375.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8733.49, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 7356.04, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10457.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7211.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8733.49, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 11538.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7932.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8733.49, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8733.49, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 13341.83, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 14784.19, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7211.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8733.49, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7211.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8762.9 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 7211.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7211.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 7716.63, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8733.49, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA - SOI : 2", "code_information": [ { "code": "6902", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22703.9, "maximum": 26142.37, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 26142.37 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 25644.42 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 24897.5 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 24897.5 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 25395.45 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 26142.37 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 22703.9 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 24897.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 26142.37 } ] } ] }, { "description": "ACUTE LEUKEMIA - SOI : 4", "code_information": [ { "code": "6904", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 70454.42, "maximum": 81196.45, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 81196.45 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 79649.86 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 77329.96 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 77329.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 78876.56 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 81196.45 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 70454.42 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 77329.96 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 81196.45 } ] } ] }, { "description": "ACUTRACK FUSION DEVICE 27.0MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "ACUTRACT FIXATION SCREW 26.0MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "ACUTE LEUKEMIA - SOI : 3", "code_information": [ { "code": "6903", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 44839.97, "maximum": 51664.21, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 51664.21 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 50680.13 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 49204.01 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 49204.01 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 50188.09 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 51664.21 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 44839.97 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 49204.01 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 51664.21 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC", "code_information": [ { "code": "280", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11853.0, "minimum": 11853.6, "maximum": 24299.9005, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14354.72, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11853.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14817.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12446.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 12209.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 17187.73, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 11853.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14354.72, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12446.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 15409.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14354.72, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 12090.67, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17187.73, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11853.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14354.72, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 18965.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 13038.96, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14354.72, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14354.72, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 21929.18, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 24299.9, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11853.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14354.72, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11853.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12998.5 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 11853.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11853.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 12683.36, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14354.72, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ACUTRACT RIXATION SCREW 24.0MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC", "code_information": [ { "code": "835", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15117.0, "minimum": 15117.78, "maximum": 30991.449, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18307.63, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 15117.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18897.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15873.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 15571.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 21920.78, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 15117.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18307.63, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15873.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 19653.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18307.63, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 15420.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 21920.78, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 15117.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18307.63, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 24188.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 16629.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18307.63, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18307.63, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 27967.89, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 30991.45, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15117.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18307.63, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15117.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17218.6 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 15117.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15117.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 16176.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18307.63, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CCMCC", "code_information": [ { "code": "285", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5042.0, "minimum": 5042.01, "maximum": 10336.1205, "payers_information": [ { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 10336.12, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5042.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6105.87, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5042.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5317.47 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 5042.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5042.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 5394.95, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6105.87, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6105.87, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5042.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 6302.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5294.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 5193.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 7310.91, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 5042.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6105.87, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5294.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 6554.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6105.87, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 5142.85, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 7310.91, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 5042.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6105.87, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 8067.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5546.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6105.87, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6105.87, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 9327.72, "additional_payer_notes": "185.00% of Medicare Rates" } ] } ] }, { "description": "ACYLCARNITINES,QL,EA", "code_information": [ { "code": "82016", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50.0, "discounted_cash": 16.0, "minimum": 15.0, "maximum": 49.0, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.61, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.91, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 23.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.82, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.91, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 16.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.64, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.69, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ADD/FROZEN SECTION TECH", "code_information": [ { "code": "88332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.0, "minimum": 33.3, "maximum": 108.78, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.97 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.06 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.69 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.69 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.6 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.97 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 47.97 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 45.69 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.97 } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "834", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 38185.0, "minimum": 38185.19, "maximum": 78279.6395, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 46242.27, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 38185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 47731.49, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 40094.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 39330.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 55368.53, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 38185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 46242.27, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40094.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 49640.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 46242.27, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 38948.9, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 55368.53, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 38185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 46242.27, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 61096.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 42003.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 46242.27, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 46242.27, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 70642.6, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 78279.64, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 46242.27, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38185.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 77702.3 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 38185.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 38185.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 40858.15, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46242.27, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ADENOVIRUS AG, IFT", "code_information": [ { "code": "87260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 14.0, "minimum": 13.2, "maximum": 43.12, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.6, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.56 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.6, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 20.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.6, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.34 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.6, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.6, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.6, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.6, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.44, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.6, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ACYLCARNITINES,QT,EA", "code_information": [ { "code": "82017", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 326.0, "discounted_cash": 16.0, "minimum": 16.87, "maximum": 319.48, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.46, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.46, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ADENOVIRUS AG, EIT", "code_information": [ { "code": "87301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 11.0, "minimum": 11.98, "maximum": 43.12, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.56 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.34 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.82, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC", "code_information": [ { "code": "283", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14406.0, "minimum": 14400.0, "maximum": 29532.833, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17445.98, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 14406.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18007.83, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15126.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 14838.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 20889.08, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 14406.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17445.98, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15126.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 18728.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17445.98, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 14694.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 20889.08, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 14406.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17445.98, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 23050.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 15846.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17445.98, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17445.98, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 26651.58, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 29532.83, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14406.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17445.98, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14406.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24127.4 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 14406.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14406.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 15414.7, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17445.98, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ADAPTER OFF TIB 360 5.0 BMT", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 9772.77, "10th_percentile": 9772.77, "90th_percentile": 36144.0, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 36381.0, "10th_percentile": 36381.0, "90th_percentile": 36381.0, "count": "1 through 10" } ] } ] }, { "description": "ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES - SOI : 1", "code_information": [ { "code": "7551", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6243.16, "maximum": 8183.43, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 8183.43 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8027.55 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7793.74 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 7793.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7949.62 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 8183.43 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 6243.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7793.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8183.43 } ] } ] }, { "description": "ADENOSINE, 5-MONOPHOSPHATE", "code_information": [ { "code": "82030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 93.0, "discounted_cash": 25.0, "minimum": 25.8, "maximum": 91.14, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.83 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 26.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.41, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 36.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.41, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.54 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 28.38, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.61, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES - SOI : 2", "code_information": [ { "code": "7552", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8139.89, "maximum": 10709.2, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 10709.2 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 10505.22 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 10199.24 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 10199.24 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 10403.22 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 10709.2 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 8139.89 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10199.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10709.2 } ] } ] }, { "description": "ADD'L IMM ADMIN <8 YR", "code_information": [ { "code": "90461", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13.86, "minimum": 4.158, "maximum": 53.606, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.86 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.86 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.86 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.86 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.86 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.86 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 13.86 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 13.86 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.86 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.86 } ] } ] }, { "description": "ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES - SOI : 4", "code_information": [ { "code": "7554", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11063.96, "maximum": 14603.32, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 14603.32 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 14325.17 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 13907.93 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 13907.93 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 14186.09 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 14603.32 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 11063.96 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13907.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14603.32 } ] } ] }, { "description": "ADM AstraZnc covid vacc-1 dose", "code_information": [ { "code": "0021A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.0, "minimum": 12.0, "maximum": 39.2, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.16 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.94 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 } ] } ] }, { "description": "ADENOVIRUS AB", "code_information": [ { "code": "86603", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 175.2, "discounted_cash": 12.0, "minimum": 12.87, "maximum": 171.696, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.77, "additional_payer_notes": "107.00% of Medicare Rates" } ] } ] }, { "description": "ADM Moderna covid vacc-1 dose", "code_information": [ { "code": "0011A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.0, "minimum": 12.0, "maximum": 39.2, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.16 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.94 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 } ] } ] }, { "description": "ADIMIN VACCINE INFLUENZA ER", "code_information": [ { "code": "90471", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 289.75, "discounted_cash": 67.0, "minimum": 22.4875, "maximum": 435.071, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 84.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 69.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 98.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 73.18, "10th_percentile": 73.18, "90th_percentile": 73.18, "count": "1 through 10" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 71.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 94.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 380.61, "10th_percentile": 380.61, "90th_percentile": 380.61, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 98.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 74.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 336.27, "10th_percentile": 336.27, "90th_percentile": 336.27, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 72.52, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ADM Moderna covid vacc-2 dose", "code_information": [ { "code": "0012A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.0, "minimum": 12.0, "maximum": 39.2, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.16 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.94 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 } ] } ] }, { "description": "ADM Pfizer covid vacc-3 dose", "code_information": [ { "code": "0003A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.0, "minimum": 12.0, "maximum": 39.2, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.16 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.94 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 } ] } ] }, { "description": "ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES - SOI : 3", "code_information": [ { "code": "7553", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11063.96, "maximum": 14603.32, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 14603.32 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 14325.17 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 13907.93 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 13907.93 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 14186.09 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 14603.32 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 11063.96 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13907.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14603.32 } ] } ] }, { "description": "ADM Pfizer tris-sucrose 2 dose", "code_information": [ { "code": "0052A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.0, "minimum": 12.0, "maximum": 39.2, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.16 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.94 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 } ] } ] }, { "description": "ADMIN ADD'L VACC INFLUENZA ER", "code_information": [ { "code": "90472", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 121.8, "minimum": 7.392, "maximum": 119.364, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 93.79, "10th_percentile": 93.79, "90th_percentile": 93.79, "count": "1 through 10" } ] } ] }, { "description": "ADM Janssen covid vac Booster", "code_information": [ { "code": "0034A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.0, "minimum": 12.0, "maximum": 39.2, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.16 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.94 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 } ] } ] }, { "description": "ADM Pfizer tris-sucrose 3 dose", "code_information": [ { "code": "0053A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.0, "minimum": 12.0, "maximum": 39.2, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.16 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.94 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 } ] } ] }, { "description": "ADM AstraZnc covid vacc-2 dose", "code_information": [ { "code": "0022A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.0, "minimum": 12.0, "maximum": 39.2, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.16 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.94 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 } ] } ] }, { "description": "ADMIN ADD'L VACC PNEUMOCOCCAL", "code_information": [ { "code": "90472", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 121.8, "minimum": 7.392, "maximum": 119.364, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 93.79, "10th_percentile": 93.79, "90th_percentile": 93.79, "count": "1 through 10" } ] } ] }, { "description": "ADM Janssen covid vacc-1 dose", "code_information": [ { "code": "0031A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.0, "minimum": 12.0, "maximum": 39.2, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.16 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.94 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 } ] } ] }, { "description": "ADMIN ADD'L VACC INFLUENZA", "code_information": [ { "code": "90472", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 121.8, "minimum": 7.392, "maximum": 119.364, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 93.79, "10th_percentile": 93.79, "90th_percentile": 93.79, "count": "1 through 10" } ] } ] }, { "description": "ADM Moderna covid vacc booster", "code_information": [ { "code": "0064A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.0, "minimum": 12.0, "maximum": 39.2, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.16 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.94 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 } ] } ] }, { "description": "ADMIN HEPATITIS B VACCINE", "code_information": [ { "code": "90471", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.09, "discounted_cash": 67.0, "minimum": 22.4875, "maximum": 435.071, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 84.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 69.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 98.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 73.18, "10th_percentile": 73.18, "90th_percentile": 73.18, "count": "1 through 10" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 71.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 94.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 380.61, "10th_percentile": 380.61, "90th_percentile": 380.61, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 98.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 74.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 336.27, "10th_percentile": 336.27, "90th_percentile": 336.27, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 72.52, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ADM Moderna covid vacc-3 dose", "code_information": [ { "code": "0013A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.0, "minimum": 12.0, "maximum": 39.2, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.16 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.94 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 } ] } ] }, { "description": "ADMIN INFLUENZA VACCINE - G0008 - 51000771", "code_information": [ { "code": "G0008", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 185.15, "discounted_cash": 44.0, "minimum": 22.4875, "maximum": 181.447, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.16 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 55.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 45.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 61.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.94 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 48.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 47.17, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ADM Pfizer covid vacc-1 dose", "code_information": [ { "code": "0001A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.0, "minimum": 12.0, "maximum": 39.2, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.16 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.94 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 } ] } ] }, { "description": "ADMIN INFLUENZA VACCINE - 90471 - 77100011", "code_information": [ { "code": "90471", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 298.75, "discounted_cash": 67.0, "minimum": 22.4875, "maximum": 435.071, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 84.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 69.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 98.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 73.18, "10th_percentile": 73.18, "90th_percentile": 73.18, "count": "1 through 10" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 71.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 94.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 380.61, "10th_percentile": 380.61, "90th_percentile": 380.61, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 98.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 74.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 336.27, "10th_percentile": 336.27, "90th_percentile": 336.27, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 72.52, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ADM Pfizer covid vacc booster", "code_information": [ { "code": "0004A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.0, "minimum": 12.0, "maximum": 39.2, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.16 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.94 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 } ] } ] }, { "description": "ADMIN INFLUENZA VIRUS VAC - G0008 - 77100003", "code_information": [ { "code": "G0008", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 154.35, "discounted_cash": 44.0, "minimum": 22.4875, "maximum": 181.447, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 55.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 45.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 61.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 48.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 47.17, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ADM Pfizer tris-sucrose Boostr", "code_information": [ { "code": "0054A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.0, "minimum": 12.0, "maximum": 39.2, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.16 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.94 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 } ] } ] }, { "description": "ADMIN PNEUMOCOCCAL VACC", "code_information": [ { "code": "G0009", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 189.4, "discounted_cash": 44.0, "minimum": 22.4875, "maximum": 185.612, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.16 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 55.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 45.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 61.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.94 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 48.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 47.17, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ADM Pfizer covid vacc-2 dose", "code_information": [ { "code": "0002A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.0, "minimum": 12.0, "maximum": 39.2, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.16 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.94 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 } ] } ] }, { "description": "ADMIN PNEUMOCOCCAL VACCINE - 90471 - 77100010", "code_information": [ { "code": "90471", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 298.75, "discounted_cash": 67.0, "minimum": 22.4875, "maximum": 435.071, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 84.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 69.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 98.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 73.18, "10th_percentile": 73.18, "90th_percentile": 73.18, "count": "1 through 10" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 71.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 94.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 380.61, "10th_percentile": 380.61, "90th_percentile": 380.61, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 98.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 74.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 336.27, "10th_percentile": 336.27, "90th_percentile": 336.27, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 72.52, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ADMIN ADD'L VACC PNEUMO ER", "code_information": [ { "code": "90472", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 121.8, "minimum": 7.392, "maximum": 119.364, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 93.79, "10th_percentile": 93.79, "90th_percentile": 93.79, "count": "1 through 10" } ] } ] }, { "description": "ADMIN VACCINE PNEUMOCOCCAL ER", "code_information": [ { "code": "90471", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 298.75, "discounted_cash": 67.0, "minimum": 22.4875, "maximum": 435.071, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 84.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 69.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 98.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 73.18, "10th_percentile": 73.18, "90th_percentile": 73.18, "count": "1 through 10" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 71.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 94.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 380.61, "10th_percentile": 380.61, "90th_percentile": 380.61, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 98.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 74.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 336.27, "10th_percentile": 336.27, "90th_percentile": 336.27, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 72.52, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ADM Pfizer tris-sucrose 1 dose", "code_information": [ { "code": "0051A", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.0, "minimum": 12.0, "maximum": 39.2, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.16 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.94 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "615", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10465.0, "minimum": 6750.0, "maximum": 21454.9105, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12674.1, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10465.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13082.26, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10989.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 10779.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 15175.42, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 10465.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12674.1, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10989.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 13605.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12674.1, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 10675.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15175.42, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10465.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12674.1, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 16745.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 11512.38, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12674.1, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12674.1, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 19361.75, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 21454.91, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10465.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12674.1, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10465.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14067.6 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 10465.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10465.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 11198.42, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12674.1, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ADMIN INFLUENZA VACC", "code_information": [ { "code": "G0008", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.09, "discounted_cash": 44.0, "minimum": 22.4875, "maximum": 181.447, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 55.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 45.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 61.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 48.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 47.17, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ADRENAL PROCEDURES - SOI : 3", "code_information": [ { "code": "4013", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11447.84, "maximum": 13164.66, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 13164.66 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 12913.91 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12537.77 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 12537.77 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12788.53 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 13164.66 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 11447.84 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12537.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13164.66 } ] } ] }, { "description": "ADMIN PNEUMOCOCCAL VACCINE - G0009 - 51000385", "code_information": [ { "code": "G0009", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 189.4, "discounted_cash": 44.0, "minimum": 22.4875, "maximum": 185.612, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 47.17, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.16 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 55.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 45.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 61.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.94 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 48.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 23.61 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 } ] } ] }, { "description": "ADRENAL PROCEDURES - SOI : 1", "code_information": [ { "code": "4011", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11447.84, "maximum": 13164.66, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 13164.66 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 12913.91 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12537.77 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 12537.77 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12788.53 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 13164.66 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 11447.84 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12537.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13164.66 } ] } ] }, { "description": "ADMIN INFLUENZA VIRUS VAC - G0008 - 51000294", "code_information": [ { "code": "G0008", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 154.35, "discounted_cash": 44.0, "minimum": 22.4875, "maximum": 181.447, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 55.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 45.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 61.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 48.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 47.17, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "AEROSOL TREATMENT", "code_information": [ { "code": "94640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1341.2, "discounted_cash": 206.0, "minimum": 85.5184, "maximum": 1314.376, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 308.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 1009.93, "10th_percentile": 1009.92, "90th_percentile": 1009.93, "count": "26" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 257.68, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 216.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 212.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 298.9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 1274.14, "10th_percentile": 1274.14, "90th_percentile": 1274.14, "count": "1 through 10" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 308.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 216.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 288.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 308.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 210.26, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 1220.49, "10th_percentile": 792.05, "90th_percentile": 1220.49, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 298.9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 308.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 226.75, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 308.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 308.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 85.52 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 206.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 308.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 206.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 206.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 1078.32, "10th_percentile": 1078.32, "90th_percentile": 1078.32, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 220.57, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 308.59, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ADRENAL PROCEDURES - SOI : 4", "code_information": [ { "code": "4014", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11447.84, "maximum": 13164.66, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 13164.66 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 12913.91 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12537.77 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 12537.77 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12788.53 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 13164.66 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 11447.84 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12537.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13164.66 } ] } ] }, { "description": "ADRENAL PROCEDURES - SOI : 2", "code_information": [ { "code": "4012", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11447.84, "maximum": 13164.66, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 13164.66 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 12913.91 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12537.77 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 12537.77 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12788.53 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 13164.66 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 11447.84 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12537.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13164.66 } ] } ] }, { "description": "ADMIN PNEUMOCOCCAL VACCINE - G0009 - 51000295", "code_information": [ { "code": "G0009", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 189.4, "discounted_cash": 44.0, "minimum": 22.4875, "maximum": 185.612, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 55.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 45.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 61.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.94 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 48.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 47.17, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "AFP SERUM LC", "code_information": [ { "code": "82105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.1, "discounted_cash": 16.0, "minimum": 11.4, "maximum": 196.98, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.32, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 23.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.32, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.94, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE WITH CCMCC", "code_information": [ { "code": "949", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9045.0, "minimum": 9045.49, "maximum": 21048.0, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10954.09, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9045.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11306.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9497.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 9316.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 13115.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 9045.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10954.09, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9497.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 11759.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10954.09, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 9226.4, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13115.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9045.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10954.09, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 14472.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9950.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10954.09, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10954.09, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 16734.16, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 18543.25, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9045.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10954.09, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9045.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21048.0 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 9045.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9045.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 9678.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10954.09, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "AEROSOL SUBSEQUENT", "code_information": [ { "code": "94640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1341.2, "discounted_cash": 206.0, "minimum": 85.5184, "maximum": 1314.376, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 308.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 89.8 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 1009.93, "10th_percentile": 1009.92, "90th_percentile": 1009.93, "count": "26" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 88.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 257.68, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 85.52 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 216.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 212.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 298.9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 85.52 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 1274.14, "10th_percentile": 1274.14, "90th_percentile": 1274.14, "count": "1 through 10" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 308.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 216.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 288.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 308.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 210.26, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 1220.49, "10th_percentile": 792.05, "90th_percentile": 1220.49, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 298.9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 87.23 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 308.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 89.8 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 226.75, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 308.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 308.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 89.8 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 85.52 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 206.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 308.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 85.52 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 206.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 206.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 1078.32, "10th_percentile": 1078.32, "90th_percentile": 1078.32, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 89.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 220.57, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 308.59, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITH CCMCC", "code_information": [ { "code": "614", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15836.0, "minimum": 12150.0, "maximum": 32463.964, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19177.49, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 15836.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 19795.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16627.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 16311.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 22962.32, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 15836.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19177.49, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16627.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 20586.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19177.49, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 16152.82, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 22962.32, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 15836.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19177.49, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 25337.73, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 17419.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19177.49, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19177.49, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 29296.75, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 32463.96, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15836.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19177.49, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15836.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23197.4 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 15836.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15836.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 16944.61, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19177.49, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "560", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8614.0, "minimum": 8614.51, "maximum": 17659.7455, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10432.17, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8614.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10768.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9045.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 8872.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 12491.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 8614.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10432.17, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9045.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 11198.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10432.17, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 8786.8, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12491.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8614.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10432.17, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 13783.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9475.96, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10432.17, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10432.17, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 15936.84, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 17659.75, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8614.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10432.17, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8614.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13308.2 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 8614.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8614.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 9217.53, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10432.17, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE WITHOUT CCMCC", "code_information": [ { "code": "950", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5237.0, "minimum": 5237.17, "maximum": 16804.0, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6342.21, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5237.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 6546.46, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5499.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 5394.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 7593.9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 5237.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6342.21, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5499.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 6808.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6342.21, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 5341.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 7593.9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 5237.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6342.21, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 8379.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5760.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6342.21, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6342.21, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 9688.76, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 10736.2, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5237.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6342.21, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5237.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16804.0 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 5237.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5237.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 5603.77, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6342.21, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "AGGLUTININS, FEBRILE, EA AG", "code_information": [ { "code": "86000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.0, "discounted_cash": 6.0, "minimum": 6.98, "maximum": 26.0, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 10.45, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 7.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.12, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 10.45, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 10.45, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.12, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 10.45, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 10.45, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 10.45, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 10.45, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.47, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.45, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "AFP QUAD SCREEN LC017319", "code_information": [ { "code": "82105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 38.0, "discounted_cash": 16.0, "minimum": 11.4, "maximum": 196.98, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.32, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 23.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.32, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.94, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "561", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6431.0, "minimum": 6431.17, "maximum": 13183.8985, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7788.15, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6431.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8038.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6752.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 6624.11, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 9325.2, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 6431.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7788.15, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6752.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 8360.52, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7788.15, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 6559.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9325.2, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6431.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7788.15, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 10289.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7074.29, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7788.15, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7788.15, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 11897.66, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 13183.9, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6431.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7788.15, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6431.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8524.85 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 6431.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6431.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 6881.35, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7788.15, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "559", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13620.0, "minimum": 13620.88, "maximum": 27922.804, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16494.89, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13620.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 17026.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14301.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 14029.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 19750.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 13620.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16494.89, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14301.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 17707.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16494.89, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 13893.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 19750.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 13620.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16494.89, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 21793.41, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 14982.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16494.89, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16494.89, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 25198.63, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 27922.8, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13620.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16494.89, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13620.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17581.3 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 13620.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13620.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 14574.34, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16494.89, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ALCOH/SUB SBI SERV > 15-30MIN", "code_information": [ { "code": "99409", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 276.97, "minimum": 54.38, "maximum": 271.4306, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.1 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.01 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.38 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.47 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.1 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 57.1 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 54.38 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.1 } ] } ] }, { "description": "AICD GENERATOR PROCEDURES", "code_information": [ { "code": "245", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 31900.0, "minimum": 19350.0, "maximum": 65395.2255, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 38631.03, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 31900.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 39875.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 33495.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 32857.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 46255.16, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 31900.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 38631.03, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33495.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 41470.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 38631.03, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 32538.1, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 46255.16, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 31900.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 38631.03, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 51040.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 35090.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 38631.03, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 38631.03, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 59015.2, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 65395.23, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31900.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 38631.03, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 31900.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46283.0 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 31900.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 31900.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 34133.12, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38631.03, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "AG SCREENING USING PT SERUM", "code_information": [ { "code": "86904", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.0, "discounted_cash": 55.0, "minimum": 36.6563, "maximum": 176.4, "payers_information": [ { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 80.53, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.66 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 83.14, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 77.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 83.14, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.65, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 80.53, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.39 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 83.14, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.49 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 61.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 83.14, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 83.14, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 38.49 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 36.66 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 55.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 83.14, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 55.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 55.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 59.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.14, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 83.14, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.49 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.76 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 69.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.66 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 57.21, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL & DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY - SOI : 2", "code_information": [ { "code": "7722", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3968.81, "maximum": 5153.76, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 5153.76 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5055.6 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4908.35 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 4908.35 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5006.51 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 5153.76 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 3968.81 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4908.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5153.76 } ] } ] }, { "description": "AG SCREENING USING RGT SERUM", "code_information": [ { "code": "86902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.0, "discounted_cash": 337.0, "minimum": 36.6563, "maximum": 180.0, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 180.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.49 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.76 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 180.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 180.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.66 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 180.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 180.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 180.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.66 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 180.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 180.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 180.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 180.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 180.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 180.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 180.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.39 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 180.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 180.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.49 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 180.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 180.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 180.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 38.49 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 36.66 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 180.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 180.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 180.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 180.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 180.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 180.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 180.0, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 180.0, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL & DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY - SOI : 1", "code_information": [ { "code": "7721", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3778.04, "maximum": 4900.47, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 4900.47 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4807.12 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4667.11 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 4667.11 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4760.45 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 4900.47 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 3778.04 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4667.11 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4900.47 } ] } ] }, { "description": "ALCOHOL & DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY - SOI : 3", "code_information": [ { "code": "7723", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5374.54, "maximum": 7026.01, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 7026.01 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6892.18 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6691.44 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 6691.44 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6825.26 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 7026.01 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 5374.54 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6691.44 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7026.01 } ] } ] }, { "description": "AICD LEAD PROCEDURES", "code_information": [ { "code": "265", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25501.0, "minimum": 18450.0, "maximum": 52278.854, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30882.78, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 25501.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 31877.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 26777.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 26266.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 36977.73, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 25501.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30882.78, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26777.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 33152.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30882.78, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 26011.94, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 36977.73, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25501.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30882.78, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 40803.01, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 28052.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30882.78, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30882.78, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 47178.48, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 52278.85, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25501.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30882.78, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25501.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33785.4 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 25501.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 25501.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 27287.01, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30882.78, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL ABUSE & DEPENDENCE - SOI : 3", "code_information": [ { "code": "7753", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9267.3, "maximum": 12210.96, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 12210.96 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 11978.37 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 11629.49 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 11629.49 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 11862.08 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 12210.96 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 9267.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11629.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12210.96 } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY", "code_information": [ { "code": "895", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10576.0, "minimum": 6279.94, "maximum": 34200.0, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12807.86, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10576.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13220.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11105.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 10893.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 15335.59, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 10576.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12807.86, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11105.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 13749.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12807.86, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 10787.83, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15335.59, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10576.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12807.86, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 16922.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 11633.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12807.86, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12807.86, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 19566.1, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 21681.35, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10576.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12807.86, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10576.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6279.94 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 10576.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10576.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 11316.61, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12807.86, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ALBUMIN SERUM", "code_information": [ { "code": "82040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.33, "discounted_cash": 4.0, "minimum": 4.95, "maximum": 78.7234, "payers_information": [ { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 6.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.41, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.05, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.18, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.41, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.41, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.41, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.41, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 4.95, "10th_percentile": 4.95, "90th_percentile": 4.95, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.41, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.41, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.19, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.18, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.41, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL ABUSE & DEPENDENCE - SOI : 4", "code_information": [ { "code": "7754", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18646.18, "maximum": 24701.01, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 24701.01 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 24230.51 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 23524.77 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 23524.77 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 23995.26 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 24701.01 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 18646.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 23524.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 24701.01 } ] } ] }, { "description": "AIRWAY INHALATION TREATMENT", "code_information": [ { "code": "94640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 574.8, "discounted_cash": 206.0, "minimum": 85.5184, "maximum": 1314.376, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 308.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 257.68, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 216.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 212.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 298.9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 308.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 216.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 288.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 308.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 210.26, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 298.9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 308.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 226.75, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 308.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 308.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 85.52 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 206.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 308.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 206.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 206.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 220.57, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 308.59, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL,ETHANOL", "code_information": [ { "code": "80320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 39.0, "minimum": 4.425, "maximum": 56.84, "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 29.37, "10th_percentile": 29.37, "90th_percentile": 29.37, "count": "17" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 35.49, "10th_percentile": 35.49, "90th_percentile": 35.49, "count": "1 through 10" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 39.0 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 31.36, "10th_percentile": 31.36, "90th_percentile": 31.36, "count": "1 through 10" } ] } ] }, { "description": "ALBUMIN, URINE OR OTHER SOURCE", "code_information": [ { "code": "82042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19.0, "discounted_cash": 7.0, "minimum": 5.7, "maximum": 18.62, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 10.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.94, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 8.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.32, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.65, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL/DRUG SCREENING", "code_information": [ { "code": "H0049", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 92.4, "minimum": 27.72, "maximum": 90.552, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.1 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.01 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.38 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.47 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.1 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 57.1 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 54.38 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.1 } ] } ] }, { "description": "ALCOHOLIC LIVER DISEASE - SOI : 1", "code_information": [ { "code": "2801", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4068.1, "maximum": 4656.18, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 4656.18 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4567.49 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4434.46 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 4434.46 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4523.15 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 4656.18 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 4068.1 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4434.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4656.18 } ] } ] }, { "description": "ALCOHOL & DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY - SOI : 4", "code_information": [ { "code": "7724", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5374.54, "maximum": 7026.01, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 7026.01 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6892.18 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6691.44 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 6691.44 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6825.26 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 7026.01 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 5374.54 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6691.44 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7026.01 } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC", "code_information": [ { "code": "896", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12809.0, "minimum": 10002.7, "maximum": 26258.614, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15511.8, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12809.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16011.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13449.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 13193.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 18573.17, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 12809.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15511.8, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13449.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 16651.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15511.8, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 13065.28, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 18573.17, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 12809.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15511.8, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 20494.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 14090.01, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15511.8, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15511.8, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 23696.8, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 26258.61, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12809.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15511.8, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12809.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10002.7 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 12809.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12809.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 13705.72, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15511.8, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ALCOHOLIC LIVER DISEASE - SOI : 4", "code_information": [ { "code": "2804", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17815.88, "maximum": 20506.71, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 20506.71 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 20116.1 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 19530.2 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 19530.2 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 19920.8 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 20506.71 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 17815.88 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19530.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 20506.71 } ] } ] }, { "description": "ALCOHOL ABUSE & DEPENDENCE - SOI : 1", "code_information": [ { "code": "7751", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4808.5, "maximum": 6272.42, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 6272.42 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6152.95 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5973.74 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 5973.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6093.21 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 6272.42 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 4808.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5973.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6272.42 } ] } ] }, { "description": "ALK PHOS ISOENZYMES", "code_information": [ { "code": "84080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200.0, "discounted_cash": 14.0, "minimum": 14.78, "maximum": 196.0, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.13, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 15.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.43, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.13, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 20.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.13, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.43, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.13, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.13, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.13, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.13, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.81, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.13, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC", "code_information": [ { "code": "897", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6965.0, "minimum": 6965.82, "maximum": 14850.0, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8435.61, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6965.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8707.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7314.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 7174.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 10100.44, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 6965.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8435.61, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7314.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 9055.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8435.61, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 7105.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10100.44, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6965.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8435.61, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 11145.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7662.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8435.61, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8435.61, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 12886.77, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 14279.93, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6965.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8435.61, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6965.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 6965.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6965.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 7453.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8435.61, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ALDOSTERONE", "code_information": [ { "code": "82088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 371.92, "discounted_cash": 40.0, "minimum": 36.44, "maximum": 364.4816, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 61.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.26 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.53 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.44 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 41.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.09, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.44 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 61.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 57.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 61.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.57, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 338.45, "10th_percentile": 338.45, "90th_percentile": 676.89, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.09, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.17 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 61.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.26 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 44.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 61.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 61.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 38.26 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 36.44 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 61.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 299.02, "10th_percentile": 299.02, "90th_percentile": 299.02, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.26 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 43.6, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.0, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL ABUSE & DEPENDENCE - SOI : 2", "code_information": [ { "code": "7752", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6158.72, "maximum": 8070.75, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 8070.75 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7917.02 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7686.43 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 7686.43 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7840.16 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 8070.75 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 6158.72 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7686.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8070.75 } ] } ] }, { "description": "ALKALOIDS, URINE,QT", "code_information": [ { "code": "80323", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30.0, "minimum": 9.0, "maximum": 60.76, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.0 } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA", "code_information": [ { "code": "894", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5163.0, "minimum": 3291.85, "maximum": 10586.1795, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6253.59, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5163.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 6454.99, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5422.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 5318.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 7487.79, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 5163.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6253.59, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5422.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 6713.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6253.59, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 5267.27, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 7487.79, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 5163.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6253.59, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 8262.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5680.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6253.59, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6253.59, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 9553.38, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 10586.18, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5163.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6253.59, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5163.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3291.85 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 5163.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5163.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 5525.47, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6253.59, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ALCOHOLIC LIVER DISEASE - SOI : 2", "code_information": [ { "code": "2802", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5218.96, "maximum": 5983.07, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 5983.07 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5869.1 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5698.16 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 5698.16 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5812.12 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 5983.07 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 5218.96 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5698.16 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5983.07 } ] } ] }, { "description": "ALLERG PF PINEAPPLE LC602770", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16.3, "discounted_cash": 5.0, "minimum": 1.0, "maximum": 479.71, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL/DRUG SERVICE 15MIN", "code_information": [ { "code": "H0050", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 192.5, "minimum": 57.75, "maximum": 188.65, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.25 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.05 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 109.76 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 109.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 111.96 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.25 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 115.25 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 109.76 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 109.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.25 } ] } ] }, { "description": "ALLERGEN PROFILE MOLD LC", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130.4, "discounted_cash": 5.0, "minimum": 1.0, "maximum": 479.71, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ALLERGAN SPECIFIC IGE,QL MULTI", "code_information": [ { "code": "86005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 248.05, "discounted_cash": 7.0, "minimum": 1.0, "maximum": 243.089, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 8.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.53, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.93, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ALCOHOLIC LIVER DISEASE - SOI : 3", "code_information": [ { "code": "2803", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7722.39, "maximum": 8869.41, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 8869.41 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8700.47 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8447.05 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 8447.05 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8616.0 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 8869.41 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 7722.39 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8447.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8869.41 } ] } ] }, { "description": "ALKALINE PHOSPHATASE", "code_information": [ { "code": "84075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 370.88, "discounted_cash": 5.0, "minimum": 5.18, "maximum": 363.4624, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.28, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 5.18, "10th_percentile": 5.18, "90th_percentile": 5.18, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.54, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.75, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "Allergen Profile, Food, IgE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 195.6, "discounted_cash": 5.0, "minimum": 1.0, "maximum": 479.71, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN PROFILE FOOD-BERRY LC", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 48.9, "discounted_cash": 5.0, "minimum": 1.0, "maximum": 479.71, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ALDOLASE", "code_information": [ { "code": "82085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.42, "discounted_cash": 9.0, "minimum": 9.71, "maximum": 142.5116, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 10.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.08, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.9, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.08, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 10.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.39, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.54, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ALLERG PROFILE SHELLFSH 062695", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 97.8, "discounted_cash": 5.0, "minimum": 1.0, "maximum": 479.71, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS - SOI : 4", "code_information": [ { "code": "8114", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12741.77, "maximum": 14656.51, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 14656.51 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 14377.34 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 13958.58 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 13958.58 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 14237.75 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 14656.51 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 12741.77 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13958.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14656.51 } ] } ] }, { "description": "ALLERGEN PROFILE FOOD-NUT LC", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 81.5, "discounted_cash": 5.0, "minimum": 1.0, "maximum": 479.71, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN PF ORANGE LC602472", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16.3, "discounted_cash": 5.0, "minimum": 1.0, "maximum": 479.71, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS WITHOUT MCC", "code_information": [ { "code": "916", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5498.0, "minimum": 3768.82, "maximum": 11272.417, "payers_information": [ { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6658.97, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5498.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3768.82 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 5498.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5498.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 5883.65, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6658.97, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6658.97, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5498.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 6873.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5773.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 5663.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 7973.17, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 5498.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6658.97, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5773.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 7148.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6658.97, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 5608.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 7973.17, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 5498.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6658.97, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 8797.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6048.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6658.97, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6658.97, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 10172.67, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 11272.42, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5498.74, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS - SOI : 2", "code_information": [ { "code": "8112", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4337.05, "maximum": 4966.27, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 4966.27 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4871.67 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4729.78 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 4729.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4824.38 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 4966.27 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 4337.05 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4729.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4966.27 } ] } ] }, { "description": "ALLERG TOTAL AREA 5 LC602632", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 230.65, "discounted_cash": 5.0, "minimum": 1.0, "maximum": 479.71, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN PROFILE FOOD BASIC LC", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 97.8, "discounted_cash": 5.0, "minimum": 1.0, "maximum": 479.71, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ALLG SPEC IGE MULTI SCRN LC", "code_information": [ { "code": "86005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3.26, "discounted_cash": 7.0, "minimum": 1.0, "maximum": 243.089, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.26 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.26 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.26 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.26 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.26 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.26 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 3.26 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3.26 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.26 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS WITH MCC", "code_information": [ { "code": "915", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12378.0, "minimum": 12378.78, "maximum": 25376.499, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14990.7, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12378.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15473.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12997.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 12750.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 17949.23, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 12378.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14990.7, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12997.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 16092.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14990.7, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 12626.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17949.23, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 12378.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14990.7, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 19806.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 13616.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14990.7, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14990.7, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 22900.74, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 25376.5, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12378.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14990.7, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12378.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13138.4 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 12378.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12378.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 13245.29, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14990.7, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN SP IGG QT/SEMIQT", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 99.4, "discounted_cash": 7.0, "minimum": 7.82, "maximum": 382.886, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.34, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.34, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.37, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ALLERGENS (46) FOODS LC", "code_information": [ { "code": "86008", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 752.3, "discounted_cash": 17.0, "minimum": 17.93, "maximum": 737.254, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.84, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.84, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.84, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.84, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.84, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.84, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 26.84, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.19, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.84, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT- SOI : 3", "code_information": [ { "code": "0073", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 96869.47, "maximum": 111651.75, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 111651.75 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 109525.05 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 106335.0 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 106335.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 108461.7 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 111651.75 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 96869.47 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 106335.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 111651.75 } ] } ] }, { "description": "ALLERGEN W/CMP RFLX AREA 4 LC", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 489.5, "discounted_cash": 5.0, "minimum": 1.0, "maximum": 479.71, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS - SOI : 1", "code_information": [ { "code": "8111", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3537.23, "maximum": 4044.12, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 4044.12 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3967.09 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3851.54 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 3851.54 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3928.57 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 4044.12 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 3537.23 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3851.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4044.12 } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT- SOI : 4", "code_information": [ { "code": "0074", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 197909.82, "maximum": 228146.46, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 228146.46 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 223800.81 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 217282.34 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 217282.34 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 221627.99 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 228146.46 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 197909.82 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 217282.34 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 228146.46 } ] } ] }, { "description": "ALLERGN PROFILE FOOD-CITRUS LC", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 81.5, "discounted_cash": 5.0, "minimum": 1.0, "maximum": 479.71, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS - SOI : 3", "code_information": [ { "code": "8113", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7077.38, "maximum": 8125.74, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 8125.74 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7970.96 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7738.8 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 7738.8 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7893.57 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 8125.74 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 7077.38 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7738.8 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8125.74 } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT- SOI : 1", "code_information": [ { "code": "0071", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 77653.55, "maximum": 89496.71, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 89496.71 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 87792.01 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 85234.96 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 85234.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 86939.66 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 89496.71 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 77653.55 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 85234.96 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 89496.71 } ] } ] }, { "description": "ALPHA 2 ANTIPLASMIN", "code_information": [ { "code": "85410", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255.0, "discounted_cash": 7.0, "minimum": 7.71, "maximum": 249.9, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.25, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.43 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.17 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.64, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.79 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 7.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.18, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.79 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 10.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.18, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.05 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.43 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 8.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 13.43 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 12.79 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGY TEST", "code_information": [ { "code": "95004", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1333.17, "discounted_cash": 808.0, "minimum": 203.26, "maximum": 1306.5066, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1210.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 213.42 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 209.36 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 808.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1010.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 203.26 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 848.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 832.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1172.25, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 203.26 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 808.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1210.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 848.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 1131.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1210.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 824.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1172.25, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 207.33 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 808.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1210.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 213.42 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 889.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1210.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1210.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 213.42 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 203.26 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 808.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1210.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 203.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 808.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 808.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 808.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 213.42 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 808.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 865.04, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1210.25, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ALPHA-1-ANTITRYPSIN TOTAL", "code_information": [ { "code": "82103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 121.4, "discounted_cash": 13.0, "minimum": 13.44, "maximum": 594.86, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.49, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.49, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ALLG SPC IGE CRUDE XTRCT EA LC", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 230.7, "discounted_cash": 5.0, "minimum": 1.0, "maximum": 479.71, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ALPHA-FETOPROTEIN(AFP)", "code_information": [ { "code": "82105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 201.0, "discounted_cash": 16.0, "minimum": 11.4, "maximum": 196.98, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.32, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 23.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.32, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.94, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ALPHA-1-ANTITRYPSIN,PHENOTYPE", "code_information": [ { "code": "82104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 52.0, "discounted_cash": 14.0, "minimum": 14.46, "maximum": 50.96, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.97, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.97, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.65, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.65, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "AMINES VAGINAL QL", "code_information": [ { "code": "82120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14.0, "discounted_cash": 5.0, "minimum": 4.2, "maximum": 14.0, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.97, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.49, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.69, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.97, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 8.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.97, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.69, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.97, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.97, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.97, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.97, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 5.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.41, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.97, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ALLG SPEC IGE CRUDE XTRC EA LC", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3.26, "discounted_cash": 5.0, "minimum": 1.0, "maximum": 479.71, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3.26 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ALPHA-FETOPROTEIN,AMNIOTIC FLUID", "code_information": [ { "code": "82106", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60.0, "discounted_cash": 17.0, "minimum": 17.0, "maximum": 58.8, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.65, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 23.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.65, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.19, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ALTERATION IN CONSCIOUSNESS - SOI : 3", "code_information": [ { "code": "0523", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8341.61, "maximum": 9583.33, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 9583.33 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 9400.79 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9126.98 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 9126.98 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9309.52 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 9583.33 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 8341.61 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9126.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9583.33 } ] } ] }, { "description": "AMINO ACIDS, 6 OR MORE QT EA", "code_information": [ { "code": "82139", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 775.0, "discounted_cash": 16.0, "minimum": 16.87, "maximum": 759.5, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.46, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.46, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [ { "code": "014", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 82421.0, "minimum": 82421.27, "maximum": 168963.6035, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 99812.16, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 82421.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 103026.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 86542.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 84893.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 119510.84, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 82421.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 99812.16, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 86542.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 107147.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 99812.16, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 84069.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 119510.84, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 82421.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 99812.16, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 131874.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 90663.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 99812.16, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 99812.16, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 152479.35, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 168963.6, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 82421.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 99812.16, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 82421.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 100217.0 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 82421.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 82421.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 88190.76, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 99812.16, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ALPHA-I ANTITRYPSIN TOTAL", "code_information": [ { "code": "82103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 183.0, "discounted_cash": 13.0, "minimum": 13.44, "maximum": 594.86, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.49, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.49, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "AMINO ACID,2-5, QT EA", "code_information": [ { "code": "82136", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 301.0, "discounted_cash": 19.0, "minimum": 19.61, "maximum": 294.98, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 29.36, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 20.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.43, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 29.36, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 27.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 29.36, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.43, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 29.36, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 21.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 29.36, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 29.36, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 29.36, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.98, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.36, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "AMINO ACIDS,MULTI,QL", "code_information": [ { "code": "82128", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50.0, "discounted_cash": 13.0, "minimum": 13.87, "maximum": 49.0, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.76, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.76, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 19.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.76, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.76, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 15.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.76, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.76, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.76, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.84, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.76, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT- SOI : 2", "code_information": [ { "code": "0072", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 77653.55, "maximum": 89496.71, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 89496.71 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 87792.01 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 85234.96 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 85234.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 86939.66 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 89496.71 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 77653.55 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 85234.96 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 89496.71 } ] } ] }, { "description": "ALTERATION IN CONSCIOUSNESS - SOI : 1", "code_information": [ { "code": "0521", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4144.72, "maximum": 4744.52, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 4744.52 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4654.15 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4518.59 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 4518.59 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4608.96 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 4744.52 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 4144.72 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4518.59 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4744.52 } ] } ] }, { "description": "AMINO ACIDS,SINGLE,QT EACH", "code_information": [ { "code": "82131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 515.2, "discounted_cash": 22.0, "minimum": 22.98, "maximum": 504.896, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 34.4, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 23.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.32, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 34.4, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 32.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 34.4, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.44, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.32, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 34.4, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 34.4, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 34.4, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 34.4, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 24.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.4, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "AMNIOINFUSION", "code_information": [ { "code": "59899", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 482.1, "minimum": 144.63, "maximum": 482.1, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.1 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.1 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.1 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.1 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.1 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.1 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 482.1 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 482.1 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.1 } ] } ] }, { "description": "Alpha-1 Antitrypsin", "code_information": [ { "code": "82103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 607.0, "discounted_cash": 13.0, "minimum": 13.44, "maximum": 594.86, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.49, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.49, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "AMINO ACIDS,QL,EA", "code_information": [ { "code": "82127", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50.0, "discounted_cash": 14.0, "minimum": 14.18, "maximum": 49.0, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 19.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.17, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "AMITRIPTYLENE", "code_information": [ { "code": "80335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65.0, "minimum": 10.5, "maximum": 196.0, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 39.65 } ] } ] }, { "description": "AMPUTATION FINGER/THUMB W FLAP", "code_information": [ { "code": "26952", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7870.02, "discounted_cash": 3080.0, "minimum": 796.27, "maximum": 7712.6196, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4611.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3080.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3850.49, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3234.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 3172.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4466.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3080.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4611.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3234.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 4312.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4611.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3142.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4466.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3080.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4611.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3388.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4611.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4611.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2517.43 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3080.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4611.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3080.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3080.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 3080.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3080.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3296.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4611.34, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ALTERATION IN CONSCIOUSNESS - SOI : 2", "code_information": [ { "code": "0522", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5375.33, "maximum": 6163.35, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 6163.35 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6045.95 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5869.86 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 5869.86 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5987.26 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 6163.35 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 5375.33 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5869.86 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6163.35 } ] } ] }, { "description": "AMINOLEVULINIC ACID", "code_information": [ { "code": "82135", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55.0, "discounted_cash": 16.0, "minimum": 16.45, "maximum": 53.9, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.85, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 23.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.78, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.85, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.6, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.63, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "475", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16404.0, "minimum": 16404.6, "maximum": 33629.4505, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16404.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17840.7 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 16404.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16404.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 17552.93, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19865.98, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19865.98, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 16404.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 20505.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17224.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 16896.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 23786.68, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 16404.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19865.98, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17224.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 21325.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19865.98, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 16732.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 23786.68, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 16404.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19865.98, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 26247.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 18045.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19865.98, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19865.98, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 30348.53, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 33629.45, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16404.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19865.98, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ALTERATION IN CONSCIOUSNESS - SOI : 4", "code_information": [ { "code": "0524", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17728.31, "maximum": 20405.75, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 20405.75 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 20017.07 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 19434.05 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 19434.05 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 19822.73 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 20405.75 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 17728.31 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 19434.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 20405.75 } ] } ] }, { "description": "AMMONIA", "code_information": [ { "code": "82140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 243.86, "discounted_cash": 14.0, "minimum": 14.57, "maximum": 238.9828, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 183.63, "10th_percentile": 183.63, "90th_percentile": 183.63, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 15.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.13, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 231.67, "10th_percentile": 231.67, "90th_percentile": 231.67, "count": "1 through 10" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.13, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 196.06, "10th_percentile": 196.06, "90th_percentile": 196.06, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.81, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "AMNIOCENTESIS", "code_information": [ { "code": "59000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1674.12, "minimum": 502.236, "maximum": 1674.12, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "476", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8981.0, "minimum": 7341.38, "maximum": 18411.2755, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10876.12, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8981.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11226.39, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9430.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 9250.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 13022.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 8981.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10876.12, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9430.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 11675.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10876.12, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 9160.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13022.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8981.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10876.12, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 14369.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9879.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10876.12, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10876.12, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 16615.05, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 18411.28, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8981.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10876.12, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8981.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7341.38 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 8981.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8981.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 9609.79, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10876.12, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ALUMINUM", "code_information": [ { "code": "82108", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 92.0, "discounted_cash": 25.0, "minimum": 21.34, "maximum": 90.16, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.14, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.41 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.98 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.34 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 26.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.95, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.34 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.14, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 35.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.14, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.99, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.95, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.77 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.14, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.41 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 28.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.14, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.14, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 22.41 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 21.34 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.14, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.26, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.14, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC", "code_information": [ { "code": "239", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 34334.0, "minimum": 33766.6, "maximum": 70386.463, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 41579.52, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 34334.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 42918.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 36051.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 35364.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 49785.55, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 34334.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 41579.52, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36051.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 44635.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 41579.52, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 35021.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49785.55, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 34334.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 41579.52, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 54935.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 37768.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 41579.52, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 41579.52, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 63519.49, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 70386.46, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 34334.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 41579.52, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 34334.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33766.6 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 34334.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 34334.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 36738.3, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41579.52, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF FINGER/THUMB - 26951 - 45000182", "code_information": [ { "code": "26951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7870.02, "discounted_cash": 3080.0, "minimum": 1537.4848, "maximum": 7712.6196, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4611.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3867.81 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3794.14 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3080.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3850.49, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3683.63 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3234.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 3172.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4466.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3683.63 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3080.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4611.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3234.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 4312.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4611.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3142.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4466.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3757.3 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3080.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4611.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3867.81 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3388.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4611.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4611.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 3867.81 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1537.48 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3080.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4611.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3683.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3080.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3080.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 3080.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3867.81 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3080.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3296.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4611.34, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "AMIKACIN", "code_information": [ { "code": "80150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 54.0, "discounted_cash": 15.0, "minimum": 15.08, "maximum": 52.92, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.57, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.31 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.82 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.1 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 15.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.87, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.1 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.57, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 21.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.57, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.87, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.58 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.57, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.31 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.57, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.57, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.31 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.1 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.57, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.31 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.57, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "AMPHETAMINE OR METHAMPHETAMINE", "code_information": [ { "code": "80326", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 56.0, "minimum": 16.8, "maximum": 54.88, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.63 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.84 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.44 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.63 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 41.63 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.63 } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CCMCC", "code_information": [ { "code": "241", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10364.0, "minimum": 10364.8, "maximum": 21247.922, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12551.82, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10364.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12956.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10883.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 10675.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 15029.02, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 10364.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12551.82, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10883.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 13474.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12551.82, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 10572.1, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15029.02, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10364.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12551.82, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 16583.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 11401.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12551.82, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12551.82, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 19174.95, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 21247.92, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10364.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12551.82, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10364.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14300.5 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 10364.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10364.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 11090.38, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12551.82, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES - SOI : 1", "code_information": [ { "code": "3051", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8739.56, "maximum": 10042.15, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 10042.15 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 9850.87 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9563.95 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 9563.95 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9755.23 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 10042.15 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 8739.56 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9563.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10042.15 } ] } ] }, { "description": "AMIODARONE LEVEL", "code_information": [ { "code": "80299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.75, "discounted_cash": 18.0, "minimum": 12.225, "maximum": 589.8424, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.9, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.31 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.82 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.3, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.1 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 19.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.03, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.1 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.9, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 26.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.9, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.03, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.58 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.9, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.31 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 20.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.9, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.9, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 54.0, "median_amount": 22.01, "10th_percentile": 22.01, "90th_percentile": 22.01, "count": "1 through 10" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.31 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.1 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.9, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.31 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.94, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.9, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC", "code_information": [ { "code": "240", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20299.0, "minimum": 17781.8, "maximum": 41614.303, "payers_information": [ { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 32479.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 22329.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24582.89, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24582.89, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 37554.37, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 41614.3, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20299.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24582.89, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20299.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17781.8 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 20299.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20299.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 21720.64, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24582.89, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24582.89, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 20299.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 25374.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 21314.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 20908.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 29434.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 20299.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24582.89, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21314.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 26389.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24582.89, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 20705.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 29434.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 20299.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24582.89, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES - SOI : 3", "code_information": [ { "code": "3053", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15195.95, "maximum": 17486.06, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 17486.06 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 17152.99 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 16653.39 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 16653.39 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 16986.46 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 17486.06 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 15195.95 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 16653.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 17486.06 } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC", "code_information": [ { "code": "616", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24615.0, "minimum": 20949.9, "maximum": 50461.8365, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 29809.41, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 24615.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 30769.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25846.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 25353.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 35692.52, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 24615.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 29809.41, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25846.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 32000.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 29809.41, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 25107.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 35692.52, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 24615.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 29809.41, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 39384.85, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 27077.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 29809.41, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 29809.41, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 45538.73, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 50461.84, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24615.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 29809.41, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24615.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20949.9 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 24615.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24615.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 26338.62, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29809.41, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "Amputation of finger/thumb - 26952 - OR36026952", "code_information": [ { "code": "26952", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4000.0, "discounted_cash": 3080.0, "minimum": 796.27, "maximum": 7712.6196, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4000.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 836.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 820.16 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3080.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3850.49, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 796.27 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3234.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 3172.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4000.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 796.27 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3080.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4000.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3234.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 4000.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4000.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3142.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4000.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 812.2 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3080.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4000.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 836.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3388.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4000.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4000.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 836.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2517.43 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3080.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4000.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 796.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3080.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3080.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 3080.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 836.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3080.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3296.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4000.0, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "474", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30073.0, "minimum": 30073.89, "maximum": 61651.4745, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 36419.48, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 30073.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 37592.36, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 31577.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 30976.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 43607.14, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 30073.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 36419.48, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31577.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 39096.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 36419.48, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 30675.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 43607.14, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 30073.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 36419.48, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 48118.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 33081.29, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 36419.48, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 36419.48, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 55636.7, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 61651.47, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 30073.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 36419.48, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30073.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 49219.0 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 30073.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 30073.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 32179.06, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36419.48, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "Amputation of toe", "code_information": [ { "code": "28820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5400.0, "discounted_cash": 3080.0, "minimum": 523.2, "maximum": 5292.0, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4611.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 549.36 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4819.2, "10th_percentile": 4819.2, "90th_percentile": 4819.2, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 538.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3080.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3850.49, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 523.2 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3234.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 3172.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4466.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 523.2 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3080.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4611.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3234.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 4312.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4611.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3142.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4466.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 533.66 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3080.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4611.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 549.36 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3388.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4611.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4611.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 549.36 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2309.48 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3080.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4611.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 523.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3080.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3080.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 3080.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 549.36 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3080.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3296.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4611.34, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "AMYLASE", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 363.46, "discounted_cash": 6.0, "minimum": 6.48, "maximum": 356.1908, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 3.07, "10th_percentile": 3.07, "90th_percentile": 3.07, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 345.29, "10th_percentile": 345.29, "90th_percentile": 345.29, "count": "1 through 10" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 330.75, "10th_percentile": 330.75, "90th_percentile": 330.75, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 218.07, "10th_percentile": 218.07, "90th_percentile": 218.07, "count": "1 through 10" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 292.22, "10th_percentile": 292.22, "90th_percentile": 292.22, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.93, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES - SOI : 4", "code_information": [ { "code": "3054", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 24566.23, "maximum": 28289.55, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 28289.55 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 27750.7 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 26942.43 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 26942.43 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 27481.28 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 28289.55 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 24566.23 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 26942.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 28289.55 } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES - SOI : 2", "code_information": [ { "code": "3052", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10852.85, "maximum": 12478.68, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 12478.68 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 12240.99 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 11884.46 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 11884.46 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12122.15 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 12478.68 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 10852.85 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11884.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12478.68 } ] } ] }, { "description": "ANAL AND PERINEAL PROCEDURES- SOI : 3", "code_information": [ { "code": "2263", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14168.62, "maximum": 16301.6, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 16301.6 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 15991.09 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 15525.33 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 15525.33 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 15835.84 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 16301.6 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 14168.62 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15525.33 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 16301.6 } ] } ] }, { "description": "ANAL AND PERINEAL PROCEDURES- SOI : 1", "code_information": [ { "code": "2261", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6339.32, "maximum": 7274.8, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 7274.8 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7136.23 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6928.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 6928.38 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7066.95 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 7274.8 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 6339.32 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6928.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7274.8 } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC", "code_information": [ { "code": "617", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13657.0, "minimum": 12970.3, "maximum": 27997.834, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16539.21, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13657.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 17071.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14340.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 14067.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 19803.35, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 13657.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16539.21, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14340.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 17754.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16539.21, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 13930.65, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 19803.35, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 13657.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16539.21, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 21851.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 15023.25, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16539.21, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16539.21, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 25266.34, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 27997.83, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13657.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16539.21, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13657.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12970.3 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 13657.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13657.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 14613.5, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16539.21, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ANAL AND PERINEAL PROCEDURES- SOI : 2", "code_information": [ { "code": "2262", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7340.08, "maximum": 8428.61, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 8428.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8268.07 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8027.25 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 8027.25 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8187.8 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 8428.61 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 7340.08 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8027.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8428.61 } ] } ] }, { "description": "ANALGESICS NON-OPIOID 6/MORE", "code_information": [ { "code": "80331", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 41.25, "minimum": 12.375, "maximum": 41.25, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.25 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.84 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.44 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.25 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 41.25 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.25 } ] } ] }, { "description": "ANALY GENE SERPINA1 COMMON VAR", "code_information": [ { "code": "81332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 607.0, "discounted_cash": 43.0, "minimum": 43.65, "maximum": 594.86, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.99 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.78 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 54.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 110.47 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 45.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 44.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.29, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 110.47 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 45.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 61.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.52, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.29, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.68 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.99 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 48.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 115.99 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 110.47 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 43.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 110.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 43.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 43.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 46.71, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "618", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10594.0, "minimum": 10594.56, "maximum": 21718.848, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12830.01, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10594.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13243.2, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11124.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 10912.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 15362.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 10594.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12830.01, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11124.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 13772.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12830.01, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 10806.49, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15362.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10594.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12830.01, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 16951.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 11654.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12830.01, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12830.01, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 19599.94, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 21718.85, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10594.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12830.01, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10594.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11792.8 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 10594.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10594.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 11336.18, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12830.01, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "349", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6883.0, "minimum": 6297.01, "maximum": 14110.4575, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8335.49, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6883.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8603.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7227.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 7089.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 9980.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 6883.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8335.49, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7227.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 8948.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8335.49, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 7020.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9980.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6883.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8335.49, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 11013.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7571.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8335.49, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8335.49, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 12733.83, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 14110.46, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6883.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8335.49, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6883.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6297.01 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 6883.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6883.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 7364.97, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8335.49, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ANCHOR SUTURE 2.8MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "ANALYZE NEUROSTIM NO PROGRAM", "code_information": [ { "code": "95970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 315.12, "discounted_cash": 125.0, "minimum": 94.536, "maximum": 308.8176, "payers_information": [ { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 137.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 121.92 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 156.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 129.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 131.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 175.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ANAL AND PERINEAL PROCEDURES- SOI : 4", "code_information": [ { "code": "2264", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14168.62, "maximum": 16301.6, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 16301.6 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 15991.09 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 15525.33 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 15525.33 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 15835.84 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 16301.6 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 14168.62 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15525.33 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 16301.6 } ] } ] }, { "description": "ANCA PROFILE (RDL) LC", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 412.5, "discounted_cash": 11.0, "minimum": 11.53, "maximum": 404.25, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 760.95, "10th_percentile": 760.95, "90th_percentile": 760.95, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 229.9, "10th_percentile": 229.9, "90th_percentile": 919.61, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.26, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ANCHOR/SCREW BN/BN,TIS/BN", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "ANALYZE NEUROSTIM SIMPLE", "code_information": [ { "code": "95970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 315.12, "discounted_cash": 125.0, "minimum": 94.536, "maximum": 308.8176, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 128.02 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 125.58 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 156.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 121.92 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 129.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 121.92 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 131.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 175.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 124.36 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 128.02 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 137.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 128.02 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 121.92 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 121.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 128.02 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH CC", "code_information": [ { "code": "348", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9852.0, "minimum": 9852.55, "maximum": 20197.7275, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11931.44, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9852.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12315.69, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10345.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 10148.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 14286.2, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 9852.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11931.44, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10345.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 12808.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11931.44, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 10049.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14286.2, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9852.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11931.44, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 15764.08, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 10837.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11931.44, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11931.44, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 18227.22, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 20197.73, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9852.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11931.44, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9852.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11466.0 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 9852.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9852.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 10542.23, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11931.44, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ANCA SCREEN EA AB LC", "code_information": [ { "code": "86036", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 412.5, "discounted_cash": 12.0, "minimum": 12.05, "maximum": 404.25, "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.29 } ] } ] }, { "description": "ANDROSTERONE", "code_information": [ { "code": "82160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 90.0, "discounted_cash": 25.0, "minimum": 25.55, "maximum": 88.2, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.83 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 26.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.05, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 35.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.05, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.54 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 28.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.34, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.25, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ANCA ANTIBODIES LC", "code_information": [ { "code": "86037", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.05, "discounted_cash": 12.0, "minimum": 11.115, "maximum": 36.309, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH MCC", "code_information": [ { "code": "347", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16539.0, "minimum": 16539.46, "maximum": 33905.893, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20029.29, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 16539.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 20674.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17366.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 17035.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 23982.22, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 16539.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20029.29, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17366.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 21501.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20029.29, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 16870.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 23982.22, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 16539.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20029.29, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 26463.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 18193.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20029.29, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20029.29, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 30598.0, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 33905.89, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16539.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20029.29, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16539.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22415.8 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 16539.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 16539.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 17697.22, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20029.29, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS - SOI : 4", "code_information": [ { "code": "1984", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11745.71, "maximum": 13508.1, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 13508.1 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 13250.8 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12864.86 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 12864.86 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 13122.16 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 13508.1 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 11745.71 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12864.86 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13508.1 } ] } ] }, { "description": "Anesth cat or mri scan", "code_information": [ { "code": "01922", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4000.0, "minimum": 263.9992, "maximum": 3920.0, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 277.2 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 271.92 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 264.0 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 264.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 269.28 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 277.2 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 277.2 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 264.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 264.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 277.2 } ] } ] }, { "description": "Andoscopy with biopsy", "code_information": [ { "code": "46606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5414.55, "discounted_cash": 1126.0, "minimum": 1126.56, "maximum": 5306.259, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1686.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1867.19 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1831.63 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1126.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1408.2, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1778.28 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1182.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 1160.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1633.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1778.28 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1126.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1686.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1182.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 1577.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1686.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1149.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1633.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1813.85 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1126.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1686.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1867.19 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1239.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1686.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1686.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 1867.19 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1778.28 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1126.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1686.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1778.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1126.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1126.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 1126.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1867.19 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1126.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1205.42, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1686.46, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ANCHOR SUTURE CORKSCREW 5.0MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "ANGIO I CONVERTING ENZYME(ACE)", "code_information": [ { "code": "82164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 207.93, "discounted_cash": 14.0, "minimum": 14.6, "maximum": 203.7714, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.17, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.17, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.62, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS - SOI : 3", "code_information": [ { "code": "1983", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6033.63, "maximum": 6922.34, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 6922.34 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6790.49 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6592.71 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 6592.71 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6724.56 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 6922.34 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 6033.63 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6592.71 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6922.34 } ] } ] }, { "description": "ANDROSTANEDIOL GLUCORONIDE", "code_information": [ { "code": "82154", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.0, "discounted_cash": 28.0, "minimum": 28.83, "maximum": 100.94, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 43.16, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.83 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 29.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 43.16, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 40.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 43.16, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.41, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.54 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 43.16, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 31.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 43.16, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 43.16, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 43.16, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.85, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.16, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ANCHOR/SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "ANOSCOPOY", "code_information": [ { "code": "46600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 319.44, "discounted_cash": 125.0, "minimum": 94.536, "maximum": 313.0512, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 156.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 129.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 131.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 175.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 137.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 148.3 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ANGIO-EXISTING S/I", "code_information": [ { "code": "75898", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3280.89, "discounted_cash": 2972.0, "minimum": 861.559, "maximum": 3280.89, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 904.64 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 887.41 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2972.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 861.56 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3121.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 3061.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 861.56 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2972.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3121.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3032.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 878.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2972.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 904.64 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3269.84, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 904.64 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 861.56 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2972.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 861.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2972.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2972.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 2972.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 904.64 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2972.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3180.66, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3280.89, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "Anesth lens surgery", "code_information": [ { "code": "00142", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4000.0, "minimum": 263.9992, "maximum": 3920.0, "payers_information": [ { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 264.0 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 264.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 269.28 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 277.2 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 277.2 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 264.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 264.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 277.2 }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 277.2 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 271.92 } ] } ] }, { "description": "ANDROSTENEDIONE", "code_information": [ { "code": "82157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 319.04, "discounted_cash": 29.0, "minimum": 28.9596, "maximum": 312.6592, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 43.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.83 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.6, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 30.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.46, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 43.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 40.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 43.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.46, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.54 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 43.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 32.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 43.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 43.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 43.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 31.33, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.83, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "Anoscopy and dilation", "code_information": [ { "code": "46604", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4000.0, "discounted_cash": 1126.0, "minimum": 1126.56, "maximum": 3920.0, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1686.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1867.19 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1831.63 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1126.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1408.2, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1778.28 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1182.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 1160.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1633.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1778.28 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1126.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1686.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1182.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 1577.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1686.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1149.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1633.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1813.85 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1126.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1686.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1867.19 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1239.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1686.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1686.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 1867.19 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1778.28 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1126.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1686.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1778.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1126.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1126.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 1126.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1867.19 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1126.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1205.42, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1686.46, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ANGIOTENSION II", "code_information": [ { "code": "82163", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 74.0, "discounted_cash": 20.0, "minimum": 20.52, "maximum": 72.52, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.72, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.83 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.75, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.72, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 28.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.72, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.93, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.75, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.54 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.72, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 22.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.72, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.72, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.72, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.72, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS - SOI : 1", "code_information": [ { "code": "1981", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3515.35, "maximum": 4018.88, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 4018.88 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3942.33 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3827.5 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 3827.5 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3904.05 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 4018.88 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 3515.35 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3827.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4018.88 } ] } ] }, { "description": "ANGINA PECTORIS", "code_information": [ { "code": "311", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5739.0, "minimum": 5633.17, "maximum": 11766.959, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6951.12, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5739.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7174.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6026.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 5912.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 8322.97, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 5739.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6951.12, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6026.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 7461.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6951.12, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 5854.78, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8322.97, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 5739.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6951.12, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 9183.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6313.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6951.12, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6951.12, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 10618.96, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 11766.96, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5739.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6951.12, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5739.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5633.17 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 5739.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5739.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 6141.78, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6951.12, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ANOSCOPY REMOVE FB", "code_information": [ { "code": "46608", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2129.94, "discounted_cash": 875.0, "minimum": 638.982, "maximum": 2087.3412, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1310.62, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1867.19 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1831.63 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 875.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1094.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1778.28 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 919.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 901.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1269.48, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1778.28 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 875.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1310.62, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 919.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 1225.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1310.62, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 893.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1269.48, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1813.85 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 875.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1310.62, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1867.19 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 963.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1310.62, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1310.62, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 1867.19 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1778.28 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 875.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1310.62, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1778.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 875.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 875.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 875.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1867.19 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 875.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 936.79, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1310.62, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ANLYS NEUROSTIM CMPLX W/PRGM", "code_information": [ { "code": "95972", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 512.65, "discounted_cash": 89.0, "minimum": 89.5, "maximum": 502.397, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 133.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 128.02 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 125.58 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 89.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 111.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 121.92 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 92.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 129.78, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 121.92 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 89.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 133.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 93.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 125.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 133.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 91.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 129.78, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 124.36 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 89.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 133.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 128.02 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 98.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 133.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 133.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 128.02 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 121.92 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 89.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 133.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 121.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 89.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 89.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 89.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 128.02 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 89.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 95.77, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 133.98, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS - SOI : 2", "code_information": [ { "code": "1982", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4240.89, "maximum": 4855.39, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 4855.39 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4762.91 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4624.19 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 4624.19 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4716.67 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 4855.39 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 4240.89 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4624.19 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4855.39 } ] } ] }, { "description": "ANTEPARTUM WITH O.R. PROCEDURE- SOI : 1", "code_information": [ { "code": "5471", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5401.9, "maximum": 6194.0, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 6194.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6076.02 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5899.05 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 5899.05 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6017.03 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 6194.0 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 5401.9 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5899.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6194.0 } ] } ] }, { "description": "ANTEPARTUM WITHOUT O.R. PROCEDURE- SOI : 3", "code_information": [ { "code": "5663", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4540.33, "maximum": 5200.64, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 5200.64 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5101.58 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4952.99 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 4952.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5052.05 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 5200.64 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 4540.33 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4952.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5200.64 } ] } ] }, { "description": "ANKLE/FOOT STRAPPING - BOTH", "code_information": [ { "code": "29540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 312.82, "discounted_cash": 152.0, "minimum": 74.32, "maximum": 395.7828, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 191.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 157.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 221.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 160.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 214.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 156.04, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 221.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 168.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 163.69, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ANOXIC & OTHER SEVERE BRAIN DAMAGE - SOI : 1", "code_information": [ { "code": "0591", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10670.69, "maximum": 12268.65, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 12268.65 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 12034.96 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 11684.43 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 11684.43 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 11918.12 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 12268.65 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 10670.69 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11684.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12268.65 } ] } ] }, { "description": "ANTEPARTUM WITHOUT O.R. PROCEDURE- SOI : 4", "code_information": [ { "code": "5664", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10887.26, "maximum": 12518.35, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 12518.35 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 12279.9 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 11922.23 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 11922.23 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12160.68 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 12518.35 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 10887.26 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11922.23 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12518.35 } ] } ] }, { "description": "ANOXIC & OTHER SEVERE BRAIN DAMAGE - SOI : 2", "code_information": [ { "code": "0592", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10670.69, "maximum": 12268.65, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 12268.65 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 12034.96 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 11684.43 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 11684.43 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 11918.12 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 12268.65 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 10670.69 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11684.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12268.65 } ] } ] }, { "description": "ANOXIC & OTHER SEVERE BRAIN DAMAGE - SOI : 3", "code_information": [ { "code": "0593", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12320.36, "maximum": 14170.64, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 14170.64 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 13900.73 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 13495.85 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 13495.85 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 13765.77 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 14170.64 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 12320.36 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13495.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14170.64 } ] } ] }, { "description": "ANTIBIOTIC SENSITIVITY, MIC OR BP", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 158.06, "discounted_cash": 8.0, "minimum": 8.65, "maximum": 154.8988, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4.27, "10th_percentile": 4.27, "90th_percentile": 4.27, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.54, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 16.15, "10th_percentile": 8.65, "90th_percentile": 32.87, "count": "1 through 10" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.82, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 31.49, "10th_percentile": 15.47, "90th_percentile": 31.49, "count": "33" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.54, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 9.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 54.0, "median_amount": 10.2, "10th_percentile": 10.2, "90th_percentile": 41.52, "count": "1 through 10" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 20.76, "10th_percentile": 20.76, "90th_percentile": 20.76, "count": "1 through 10" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 13.67, "10th_percentile": 13.67, "90th_percentile": 27.82, "count": "25" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.26, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "Anti-Mullerian Hormone (AMH)", "code_information": [ { "code": "82166", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 240.0, "discounted_cash": 38.0, "minimum": 23.8868, "maximum": 235.2, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 39.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 56.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 54.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 218.4, "10th_percentile": 218.4, "90th_percentile": 218.4, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 56.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 42.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 41.32, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 57.81, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ANOXIC & OTHER SEVERE BRAIN DAMAGE - SOI : 4", "code_information": [ { "code": "0594", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15435.19, "maximum": 17761.89, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 17761.89 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 17423.57 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 16916.09 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 16916.09 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 17254.41 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 17761.89 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 15435.19 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 16916.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 17761.89 } ] } ] }, { "description": "ANTEPARTUM WITH O.R. PROCEDURE- SOI : 2", "code_information": [ { "code": "5472", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6660.66, "maximum": 7645.28, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 7645.28 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7499.66 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7281.22 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 7281.22 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7426.85 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 7645.28 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 6660.66 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7281.22 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7645.28 } ] } ] }, { "description": "ANTINUCLEAR ANTIBODIES TITER", "code_information": [ { "code": "86039", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130.0, "discounted_cash": 11.0, "minimum": 11.16, "maximum": 127.4, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.71, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.71, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 15.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.71, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.71, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.71, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.71, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.71, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.94, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.71, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ANTI-PHOSPHATIDYLSERINE AB", "code_information": [ { "code": "86148", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 58.0, "discounted_cash": 16.0, "minimum": 16.07, "maximum": 56.84, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.3, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.3, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 17.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.06, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ANTEPARTUM WITH O.R. PROCEDURE- SOI : 3", "code_information": [ { "code": "5473", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10211.75, "maximum": 11739.52, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 11739.52 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 11515.91 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 11180.5 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 11180.5 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 11404.11 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 11739.52 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 10211.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11180.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11739.52 } ] } ] }, { "description": "ANTEPARTUM WITH O.R. PROCEDURE- SOI : 4", "code_information": [ { "code": "5474", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17090.33, "maximum": 19670.19, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 19670.19 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 19295.52 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 18733.52 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 18733.52 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 19108.19 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 19670.19 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 17090.33 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 18733.52 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 19670.19 } ] } ] }, { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC", "code_information": [ { "code": "268", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 47590.0, "minimum": 12874.7, "maximum": 97561.099, "payers_information": [ { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 57632.43, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 88042.94, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 97561.1, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 47590.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 57632.43, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 47590.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12874.7 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 47590.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 47590.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 50922.13, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 57632.43, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 57632.43, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 47590.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 59488.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 49970.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 49018.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 69006.63, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 47590.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 57632.43, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 49970.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 61868.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 57632.43, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 48542.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 69006.63, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 47590.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 57632.43, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 76145.25, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 52349.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 57632.43, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ANTIBODY SCREEN, RBC", "code_information": [ { "code": "86850", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 240.25, "discounted_cash": 49.0, "minimum": 36.6563, "maximum": 235.445, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 73.44, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.49 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 180.91, "10th_percentile": 180.91, "90th_percentile": 180.91, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.76 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 61.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.66 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 50.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 71.14, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.66 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 73.44, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 51.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 68.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 73.44, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.04, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 218.63, "10th_percentile": 218.63, "90th_percentile": 218.63, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 71.14, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.39 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 73.44, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.49 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 53.97, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 73.44, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 73.44, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 38.49 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 36.66 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 49.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 73.44, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 49.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 49.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 193.16, "10th_percentile": 193.16, "90th_percentile": 193.16, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 52.49, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 73.44, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ANTEPARTUM WITHOUT O.R. PROCEDURE- SOI : 1", "code_information": [ { "code": "5661", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3043.11, "maximum": 3474.42, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 3474.42 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3408.24 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3308.97 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 3308.97 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3375.15 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 3474.42 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 3043.11 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3308.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3474.42 } ] } ] }, { "description": "ANTEPARTUM WITHOUT O.R. PROCEDURE- SOI : 2", "code_information": [ { "code": "5662", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3763.97, "maximum": 4305.53, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 4305.53 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4223.52 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4100.5 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 4100.5 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4182.51 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 4305.53 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 3763.97 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4100.5 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4305.53 } ] } ] }, { "description": "APOLIPOPROTEIN, EA", "code_information": [ { "code": "82172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130.53, "discounted_cash": 21.0, "minimum": 21.09, "maximum": 127.9194, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.57, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.36, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.58, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 124.0, "10th_percentile": 124.0, "90th_percentile": 124.0, "count": "1 through 10" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.57, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.57, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.51, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.58, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.57, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 23.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.57, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.57, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.57, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.57, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.57, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ANTIDEPRESSANT NOT SPECIFIED", "code_information": [ { "code": "80338", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200.0, "minimum": 39.6494, "maximum": 196.0, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.63 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.84 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.44 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.63 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 41.63 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.63 } ] } ] }, { "description": "ANTIBODY IDENTIFICATION", "code_information": [ { "code": "86870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1047.1, "discounted_cash": 337.0, "minimum": 68.76, "maximum": 1026.158, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 505.16, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 72.2 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.82 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 337.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 421.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.76 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 354.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 347.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 489.3, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.76 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 337.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 505.16, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 354.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 472.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 505.16, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.2, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 489.3, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 70.14 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 337.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 505.16, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 72.2 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 371.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 505.16, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 505.16, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 72.2 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 68.76 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 337.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 505.16, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 337.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 337.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 337.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 72.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 337.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 361.07, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 505.16, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ANTIDEPRESSANTS CLASS 6/MORE", "code_information": [ { "code": "80334", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 41.25, "minimum": 12.375, "maximum": 41.25, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.25 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.84 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.44 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.25 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 41.25 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.25 } ] } ] }, { "description": "APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS - SOI : 2", "code_information": [ { "code": "2332", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11255.5, "maximum": 12942.91, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 12942.91 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 12696.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12326.58 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 12326.58 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12573.12 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 12942.91 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 11255.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12326.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12942.91 } ] } ] }, { "description": "ANTINUCLEAR ANTIBODIES (ANA)", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 219.52, "discounted_cash": 12.0, "minimum": 12.09, "maximum": 215.1296, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 5.97, "10th_percentile": 5.97, "90th_percentile": 5.97, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.53, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 16.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.33, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 199.76, "10th_percentile": 199.76, "90th_percentile": 199.76, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.53, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 176.49, "10th_percentile": 176.49, "90th_percentile": 176.49, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.94, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ANTIDEPRESSANTS CLASS 1 OR 2", "code_information": [ { "code": "80332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200.0, "minimum": 45.83, "maximum": 196.0, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.12 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.2 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.83 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.75 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.12 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 48.12 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 45.83 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.12 } ] } ] }, { "description": "ANTIEPILEPTICS NOS 1-3", "code_information": [ { "code": "80339", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 399.2, "minimum": 45.83, "maximum": 391.216, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.12 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.2 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.83 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.75 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.12 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 48.12 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 45.83 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.12 } ] } ] }, { "description": "APPENDIX PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "399", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8740.0, "minimum": 8550.0, "maximum": 17918.1275, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10584.81, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8740.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10925.69, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9177.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 9002.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 12673.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 8740.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10584.81, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9177.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 11362.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10584.81, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 8915.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12673.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8740.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10584.81, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 13984.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9614.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10584.81, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10584.81, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 16170.02, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 17918.13, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8740.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10584.81, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8740.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14353.4 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 8740.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8740.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 9352.39, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10584.81, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ANTISTREPTOLYSIN O TITER", "code_information": [ { "code": "86060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.0, "discounted_cash": 7.0, "minimum": 7.3, "maximum": 148.96, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 10.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.59, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 10.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 10.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 10.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.59, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 10.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 10.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 10.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 10.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.93, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ANTIEPILEPTICS NOS 7/MORE", "code_information": [ { "code": "80341", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 41.25, "minimum": 12.375, "maximum": 41.25, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.25 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.84 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.44 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.25 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 41.25 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.25 } ] } ] }, { "description": "ANTIGLO BULIN,TECHNIQUE", "code_information": [ { "code": "86922", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 515.1, "discounted_cash": 160.0, "minimum": 68.76, "maximum": 703.15, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 240.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 200.49, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 165.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 232.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 240.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 168.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 224.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 240.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 232.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 240.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 176.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 240.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 240.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 68.76 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 160.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 240.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 160.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 160.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 171.62, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 240.1, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "APPL LONG ARM SPLINT", "code_information": [ { "code": "29105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 942.34, "discounted_cash": 152.0, "minimum": 74.32, "maximum": 923.4932, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 191.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 157.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 221.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 160.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 214.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 156.04, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 221.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 168.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 163.69, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC", "code_information": [ { "code": "269", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29601.0, "minimum": 5852.46, "maximum": 60683.2185, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 35847.5, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 29601.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 37001.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 31081.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 30489.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 42922.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 29601.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 35847.5, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 31081.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 38482.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 35847.5, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 30193.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 42922.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 29601.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 35847.5, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 47362.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 32561.76, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 35847.5, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 35847.5, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 54762.9, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 60683.22, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 29601.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 35847.5, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29601.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5852.46 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 29601.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 29601.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 31673.68, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35847.5, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "Antineutrophil Cytoplasmic AB(", "code_information": [ { "code": "86037", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.05, "discounted_cash": 12.0, "minimum": 11.115, "maximum": 36.309, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ANTIHUMAN GLOBULIN TEST (COOMBS TEST)", "code_information": [ { "code": "86885", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 515.1, "discounted_cash": 160.0, "minimum": 36.6563, "maximum": 504.798, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 240.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.49 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.76 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 200.49, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.66 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 165.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 232.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.66 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 240.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 168.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 224.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 240.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 232.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.39 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 240.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.49 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 176.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 240.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 240.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 38.49 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 36.66 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 160.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 240.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 160.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 160.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 171.62, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 240.1, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "APPL, FINGER SPLINT, STATIC - 29130 - 45001005", "code_information": [ { "code": "29130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 353.02, "discounted_cash": 125.0, "minimum": 50.31, "maximum": 657.7956, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 265.82, "10th_percentile": 265.82, "90th_percentile": 285.01, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 156.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 129.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 131.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 175.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 137.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ANTIPSYCHOTICS NOS 1-3", "code_information": [ { "code": "80342", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 56.0, "minimum": 16.8, "maximum": 54.88, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.63 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.84 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.44 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.63 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 41.63 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.63 } ] } ] }, { "description": "ANTIPROTHROMBIN ANTIBODY", "code_information": [ { "code": "86849", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255.0, "minimum": 30.3785, "maximum": 249.9, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 } ] } ] }, { "description": "APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS - SOI : 4", "code_information": [ { "code": "2334", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17316.29, "maximum": 19930.7, "payers_information": [ { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 17316.29 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 18981.62 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 19930.7 }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 19930.7 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 19551.07 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 18981.62 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 18981.62 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 19361.25 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 19930.7 } ] } ] }, { "description": "ANTIPSYCHOTICS NOS 7/MORE", "code_information": [ { "code": "80344", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 41.25, "minimum": 12.375, "maximum": 41.25, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.25 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.84 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.44 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.25 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 41.25 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.25 } ] } ] }, { "description": "ANTITHROMBIN III, ACTIVITY", "code_information": [ { "code": "85300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 280.9, "discounted_cash": 11.0, "minimum": 11.85, "maximum": 275.282, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.74, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.43 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.17 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.79 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.18, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.79 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.74, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.74, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.18, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.05 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.74, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.43 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.74, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.74, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 13.43 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 12.79 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.74, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.74, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND)", "code_information": [ { "code": "29125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 998.21, "discounted_cash": 125.0, "minimum": 74.32, "maximum": 978.2458, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.04 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.55 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 156.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 129.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 131.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 175.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.81 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.04 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 137.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 78.04 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS - SOI : 1", "code_information": [ { "code": "2341", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5738.09, "maximum": 6581.61, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 6581.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6456.24 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6268.2 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 6268.2 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6393.56 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 6581.61 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 5738.09 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6268.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6581.61 } ] } ] }, { "description": "ANTITHROMBIN III, AG ASSAY", "code_information": [ { "code": "85301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 39.0, "discounted_cash": 10.0, "minimum": 10.81, "maximum": 38.22, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.43 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.17 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.79 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.79 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 15.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.05 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.43 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 13.43 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 12.79 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS - SOI : 3", "code_information": [ { "code": "2333", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17316.29, "maximum": 19930.7, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 19930.7 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 19551.07 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 18981.62 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 18981.62 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 19361.25 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 19930.7 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 17316.29 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 18981.62 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 19930.7 } ] } ] }, { "description": "APPLY FINGER SPLINT-STATIC", "code_information": [ { "code": "29130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 378.5, "discounted_cash": 125.0, "minimum": 50.31, "maximum": 657.7956, "payers_information": [ { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.04 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 265.82, "10th_percentile": 265.82, "90th_percentile": 285.01, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.55 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 156.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 129.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 131.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 175.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.81 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.04 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 137.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 78.04 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITH CC", "code_information": [ { "code": "398", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11240.0, "minimum": 11240.35, "maximum": 23042.7175, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13612.06, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11240.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14050.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11802.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 11577.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 16298.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 11240.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13612.06, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11802.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 14612.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13612.06, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 11465.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16298.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11240.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13612.06, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 17984.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 12364.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13612.06, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13612.06, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 20794.65, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 23042.72, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11240.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13612.06, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11240.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22315.1 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 11240.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11240.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 12027.17, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13612.06, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ANTIVERT 12.5 MG TABLET", "drug_information": { "unit": 12.5, "type": "ME" }, "code_information": [ { "code": "00904651661", "type": "NDC" }, { "code": "J8597", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 3.01, "10th_percentile": 3.01, "90th_percentile": 3.02, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 3.8, "10th_percentile": 3.8, "90th_percentile": 3.8, "count": "1 through 10" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 3.64, "10th_percentile": 3.64, "90th_percentile": 3.64, "count": "1 through 10" } ] } ] }, { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS - SOI : 4", "code_information": [ { "code": "2344", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13634.62, "maximum": 15685.93, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 15685.93 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 15387.15 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 14938.98 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 14938.98 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 15237.76 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 15685.93 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 13634.62 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14938.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15685.93 } ] } ] }, { "description": "Apply long arm splint", "code_information": [ { "code": "29105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 403.86, "discounted_cash": 152.0, "minimum": 74.32, "maximum": 923.4932, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 191.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 157.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 221.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 160.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 214.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 156.04, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 221.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 168.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 163.69, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "APPLICATION FOREARM CAST BOTH", "code_information": [ { "code": "29075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 706.74, "discounted_cash": 263.0, "minimum": 138.5787, "maximum": 692.6052, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 329.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 271.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 381.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 276.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 368.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 268.58, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 381.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 289.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 281.74, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITH MCC", "code_information": [ { "code": "397", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17212.0, "minimum": 17212.3, "maximum": 35285.3175, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20844.16, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 17212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 21515.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18072.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 17728.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 24957.91, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 17212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20844.16, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18072.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 22376.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20844.16, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 17556.55, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 24957.91, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 17212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20844.16, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 27539.76, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 18933.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20844.16, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20844.16, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 31842.85, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 35285.32, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20844.16, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17212.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24816.8 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 17212.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 18417.21, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20844.16, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "APPLY LONG LEG SPLINT", "code_information": [ { "code": "29505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 942.34, "discounted_cash": 152.0, "minimum": 74.32, "maximum": 923.4932, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 709.59, "10th_percentile": 709.58, "90th_percentile": 709.59, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 191.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 157.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 221.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 160.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 214.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 156.04, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 221.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 168.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 163.69, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "Application of finger splint - 29131 - 51000144", "code_information": [ { "code": "29131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 167.7, "discounted_cash": 55.0, "minimum": 50.31, "maximum": 164.346, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 83.14, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.04 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.55 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 69.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 57.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 80.53, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 83.14, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 77.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 83.14, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.65, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 80.53, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.81 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 83.14, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.04 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 61.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 83.14, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 83.14, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 78.04 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 55.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 83.14, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 55.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 55.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 59.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.14, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "APO E GENOTYPING", "code_information": [ { "code": "81401", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 603.0, "discounted_cash": 137.0, "minimum": 137.0, "maximum": 590.94, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 205.09, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 160.98 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.91 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.31 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 141.11, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 198.65, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.31 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 205.09, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 143.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 191.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 205.09, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 139.74, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 198.65, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.38 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 205.09, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 160.98 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 150.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 205.09, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 205.09, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 160.98 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 153.31 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 137.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 205.09, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 137.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 137.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 160.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 137.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 146.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 205.09, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "APPL FINGER SPLINT, DYNAMIC", "code_information": [ { "code": "29131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 167.7, "discounted_cash": 55.0, "minimum": 50.31, "maximum": 164.346, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 83.14, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 69.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 57.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 80.53, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 83.14, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 58.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 77.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 83.14, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.65, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 80.53, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 83.14, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 61.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 83.14, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 83.14, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 55.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 83.14, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 55.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 55.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 59.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 83.14, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "Apply short leg cast - 29405 - 51000152", "code_information": [ { "code": "29405", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 706.74, "discounted_cash": 263.0, "minimum": 138.5787, "maximum": 697.6032, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 329.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 271.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 381.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 276.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 368.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 268.58, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 381.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 289.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 281.74, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "Application of paste boot", "code_information": [ { "code": "29580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 403.86, "discounted_cash": 152.0, "minimum": 121.158, "maximum": 395.7828, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 191.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 157.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 221.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 160.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 214.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 156.04, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 221.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 168.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 163.69, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS - SOI : 1", "code_information": [ { "code": "2331", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9533.12, "maximum": 10957.09, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 10957.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 10748.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 10435.32 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 10435.32 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 10644.03 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 10957.09 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 9533.12 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10435.32 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10957.09 } ] } ] }, { "description": "APPL FOREARM SPLINT", "code_information": [ { "code": "29125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 745.36, "discounted_cash": 125.0, "minimum": 74.32, "maximum": 978.2458, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 561.26, "10th_percentile": 561.26, "90th_percentile": 561.26, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 156.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 129.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 131.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 175.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 678.28, "10th_percentile": 678.28, "90th_percentile": 678.28, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 137.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 599.27, "10th_percentile": 599.27, "90th_percentile": 599.27, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "APPLY SHORT LEG SPLINT - BOTH", "code_information": [ { "code": "29515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 942.34, "discounted_cash": 152.0, "minimum": 74.32, "maximum": 923.4932, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.04 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 709.58, "10th_percentile": 709.58, "90th_percentile": 709.59, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.55 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 191.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 157.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 221.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 160.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 214.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 156.04, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 508.86, "10th_percentile": 508.86, "90th_percentile": 508.86, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 221.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.81 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.04 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 168.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 78.04 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 757.64, "10th_percentile": 757.64, "90th_percentile": 757.64, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 163.69, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "APPLICATON ON-BODY INJECTOR", "code_information": [ { "code": "96377", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 113.64, "discounted_cash": 44.0, "minimum": 34.092, "maximum": 111.3672, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.94 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.74 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 55.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.94 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 45.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.94 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 61.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.14 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.94 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 48.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 62.94 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 59.94 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.94 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 47.17, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS - SOI : 2", "code_information": [ { "code": "2342", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7560.56, "maximum": 8682.81, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 8682.81 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8517.43 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8269.35 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 8269.35 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8434.73 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 8682.81 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 7560.56 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8269.35 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8682.81 } ] } ] }, { "description": "APPL SHORT ARM SPLINT DYNAMIC", "code_information": [ { "code": "29126", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 315.12, "discounted_cash": 125.0, "minimum": 74.32, "maximum": 308.8176, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.04 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.55 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 156.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 129.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 131.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 175.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.81 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.04 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 137.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 78.04 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ARTHROERISIS PROSTOP 7X12MM IMPLANT", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 9772.77, "10th_percentile": 9772.77, "90th_percentile": 36144.0, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 36381.0, "10th_percentile": 36381.0, "90th_percentile": 36381.0, "count": "1 through 10" } ] } ] }, { "description": "Apply forearm splint - 29126 - 51000142", "code_information": [ { "code": "29126", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 315.12, "discounted_cash": 125.0, "minimum": 74.32, "maximum": 308.8176, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 156.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 129.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 131.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 175.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 137.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS - SOI : 3", "code_information": [ { "code": "2343", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13634.62, "maximum": 15685.93, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 15685.93 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 15387.15 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 14938.98 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 14938.98 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 15237.76 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 15685.93 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 13634.62 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 14938.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 15685.93 } ] } ] }, { "description": "APPL SHORT LEG SPLINT", "code_information": [ { "code": "29515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 942.34, "discounted_cash": 152.0, "minimum": 74.32, "maximum": 923.4932, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 709.58, "10th_percentile": 709.58, "90th_percentile": 709.59, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 191.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 157.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 221.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 160.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 214.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 156.04, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 508.86, "10th_percentile": 508.86, "90th_percentile": 508.86, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 221.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 168.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 757.64, "10th_percentile": 757.64, "90th_percentile": 757.64, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 163.69, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "Apply long leg cast brace", "code_information": [ { "code": "29358", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 706.74, "discounted_cash": 263.0, "minimum": 138.5787, "maximum": 692.6052, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 329.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 271.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 381.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 276.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 368.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 268.58, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 381.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 289.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 281.74, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "Application long leg splint", "code_information": [ { "code": "29505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 403.86, "discounted_cash": 152.0, "minimum": 74.32, "maximum": 923.4932, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.04 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.55 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 191.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 157.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 221.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 160.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 214.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 156.04, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 221.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.81 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.04 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 168.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 78.04 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 163.69, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "APPL SHRT LEG CAST", "code_information": [ { "code": "29405", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 706.74, "discounted_cash": 263.0, "minimum": 138.5787, "maximum": 697.6032, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 329.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 271.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 381.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 276.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 368.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 268.58, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 381.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 289.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 281.74, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ASCORBIC ACID (VITAMIN C)", "code_information": [ { "code": "82180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36.0, "discounted_cash": 9.0, "minimum": 9.89, "maximum": 35.28, "payers_information": [ { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.34, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 10.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.58, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.36, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 10.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.34, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 13.85, "additional_payer_notes": "140.00% of Medicare Rates" } ] } ] }, { "description": "APPLY SHORT LEG CAST - BOTH", "code_information": [ { "code": "29405", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 548.12, "discounted_cash": 263.0, "minimum": 138.5787, "maximum": 697.6032, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 329.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 271.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 381.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 276.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 368.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 268.58, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 381.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 289.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 281.74, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "Application lower leg splint", "code_information": [ { "code": "29515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 403.86, "discounted_cash": 152.0, "minimum": 74.32, "maximum": 923.4932, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 191.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 157.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 221.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 160.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 214.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 156.04, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 221.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 168.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 163.69, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "APPL, FINGER SPLINT, STATIC - 29130 - 43001002", "code_information": [ { "code": "29130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 671.22, "discounted_cash": 125.0, "minimum": 50.31, "maximum": 657.7956, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 156.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 129.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 131.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 175.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 137.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ASPERGILLUS AB", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50.0, "discounted_cash": 15.0, "minimum": 15.0, "maximum": 49.0, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.53, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "APRESOLINE 20 MG/ML INJECTION", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00517090125", "type": "NDC" }, { "code": "J0360", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 28.24, "10th_percentile": 28.24, "90th_percentile": 28.24, "count": "1 through 10" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 34.13, "10th_percentile": 34.13, "90th_percentile": 34.13, "count": "1 through 10" } ] } ] }, { "description": "Application of finger splint - 29130 - 51000143", "code_information": [ { "code": "29130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 167.7, "discounted_cash": 125.0, "minimum": 50.31, "maximum": 657.7956, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 167.7, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 156.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 129.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.7, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 167.7, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 131.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 167.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 167.7, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.7, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 167.7, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 137.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 167.7, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 167.7, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 167.7, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 167.7, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "APPLICATION HAND/WRIST CAST BO", "code_information": [ { "code": "29085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 407.33, "discounted_cash": 152.0, "minimum": 121.158, "maximum": 399.1834, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 145.51 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 142.74 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 191.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 157.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 221.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 160.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 214.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 156.04, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 221.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 141.35 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 145.51 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 168.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 145.51 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 145.51 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 163.69, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "Aspirate/inj ganglion cyst - 20612 - OR36020612", "code_information": [ { "code": "20612", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1914.15, "discounted_cash": 288.0, "minimum": 220.23, "maximum": 1914.15, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 432.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1914.15 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1914.15 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 361.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1914.15 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 303.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 297.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 419.01, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1914.15 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 432.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 303.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 404.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 432.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 419.01, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1914.15 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 432.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1914.15 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 317.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 432.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 432.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 1914.15 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1914.15 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 432.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1914.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1914.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 309.2, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 432.59, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ARTERIAL CATH SAMPLING/MONTOR", "code_information": [ { "code": "36620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100.87, "minimum": 30.261, "maximum": 1215.984, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 100.87 } ] } ] }, { "description": "Application of long arm cast", "code_information": [ { "code": "29065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 706.74, "discounted_cash": 263.0, "minimum": 138.5787, "maximum": 692.6052, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 145.51 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 142.74 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 329.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 271.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 381.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 276.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 368.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 268.58, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 381.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 141.35 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 145.51 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 289.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 145.51 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 145.51 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 281.74, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "APPLICATION LONG ARM SPLINT (S", "code_information": [ { "code": "29105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 403.86, "discounted_cash": 152.0, "minimum": 74.32, "maximum": 923.4932, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.04 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.55 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 191.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 157.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 221.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 160.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 214.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 156.04, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 221.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.81 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.04 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 168.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 78.04 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 78.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 163.69, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ASPIRATE/INJECT THYROID CYST", "code_information": [ { "code": "60300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1718.55, "discounted_cash": 666.0, "minimum": 506.2689, "maximum": 1684.179, "payers_information": [ { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 933.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 679.99, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 966.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 516.4 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 531.58 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 733.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 531.58 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 506.27 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 506.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 531.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 713.33, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 531.58 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 521.46 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 833.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 506.27 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 686.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 966.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 506.27 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 699.99, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "ARTHROSCOPY", "code_information": [ { "code": "509", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16637.6, "maximum": 18000.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16637.6 } ] } ] }, { "description": "Apply forearm splint - 29125 - 51000141", "code_information": [ { "code": "29125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 319.44, "discounted_cash": 125.0, "minimum": 74.32, "maximum": 978.2458, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 156.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 129.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 131.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 175.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 137.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 74.32 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "Application of forearm cast", "code_information": [ { "code": "29075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 706.74, "discounted_cash": 263.0, "minimum": 138.5787, "maximum": 692.6052, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 329.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 271.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 381.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 276.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 368.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 268.58, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 381.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 289.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 281.74, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ASPIRATION OF HEMATOMA - 10160 - 36100006", "code_information": [ { "code": "10160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 932.4, "discounted_cash": 382.0, "minimum": 222.13, "maximum": 913.752, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 572.92, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 478.39, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 394.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 554.93, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 572.92, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 401.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 535.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 572.92, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 554.93, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 572.92, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 420.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 572.92, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 572.92, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 222.13 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 382.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 572.92, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 382.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 382.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 409.5, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 572.92, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "Artificial insemination", "code_information": [ { "code": "58322", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 482.1, "discounted_cash": 190.0, "minimum": 144.63, "maximum": 482.1, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 284.91, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.1 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.1 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 237.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.1 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 196.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 275.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.1 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 284.91, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 199.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 266.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 284.91, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 194.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 275.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.1 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 284.91, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.1 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 209.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 284.91, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 284.91, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 482.1 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 482.1 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 190.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 284.91, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 190.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 190.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 203.64, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 284.91, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ARSENIC", "code_information": [ { "code": "82175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 169.0, "discounted_cash": 18.0, "minimum": 18.97, "maximum": 165.62, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.41 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.98 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.34 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 19.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.34 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 26.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.77 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.41 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 20.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 22.41 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 21.34 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.3, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "Application of long leg cast - 29345 - 51000149", "code_information": [ { "code": "29345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 706.74, "discounted_cash": 263.0, "minimum": 138.5787, "maximum": 692.6052, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 145.51 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 142.74 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 329.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 271.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 381.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 276.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 368.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 268.58, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 381.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 141.35 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 145.51 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 289.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 145.51 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 145.51 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 281.74, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ASSAY CARBAMAZEPINE FREE", "code_information": [ { "code": "80157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 171.0, "discounted_cash": 13.0, "minimum": 13.25, "maximum": 167.58, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.84, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.31 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.82 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.1 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.21, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.1 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.84, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 18.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.84, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.21, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.58 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.84, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.31 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.84, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.84, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.31 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.1 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.84, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.31 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.84, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ASPIRATE/INJECT GANGLION CYST", "code_information": [ { "code": "20612", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 734.1, "discounted_cash": 288.0, "minimum": 220.23, "maximum": 1914.15, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 432.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 361.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 303.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 297.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 419.01, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 432.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 303.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 404.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 432.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 419.01, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 432.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 317.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 432.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 432.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 734.1 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 432.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 309.2, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 432.59, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ARTERIAL PUNCTURE", "code_information": [ { "code": "36600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 794.08, "discounted_cash": 125.0, "minimum": 47.0157, "maximum": 778.1984, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.37 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 597.95, "10th_percentile": 597.95, "90th_percentile": 597.95, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.43 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 156.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.02 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 129.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.02 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 131.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 175.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.37 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 137.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 49.37 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 47.02 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.37 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "Application of long leg cast - 29365 - 51000151", "code_information": [ { "code": "29365", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 706.74, "discounted_cash": 263.0, "minimum": 138.5787, "maximum": 692.6052, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 145.51 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 142.74 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 329.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 271.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 381.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 276.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 368.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 268.58, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 381.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 141.35 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 145.51 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 289.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 145.51 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 145.51 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 281.74, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ASSAY IGE LC602632", "code_information": [ { "code": "82785", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 230.7, "discounted_cash": 16.0, "minimum": 16.46, "maximum": 226.086, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 8.13, "10th_percentile": 8.13, "90th_percentile": 8.13, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.87, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.87, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 121.12, "10th_percentile": 121.12, "90th_percentile": 121.12, "count": "1 through 10" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.64, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ASSAY OF PROTEIN ANY SOURCE", "code_information": [ { "code": "84160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18.0, "discounted_cash": 5.0, "minimum": 5.4, "maximum": 17.64, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.13, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 7.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.72, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.13, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ASPERGILLUS AG EIA", "code_information": [ { "code": "87305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 11.0, "minimum": 11.98, "maximum": 43.12, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.56 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.34 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.82, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "APPLICATION SHORT LEG CAST", "code_information": [ { "code": "29405", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 711.84, "discounted_cash": 263.0, "minimum": 138.5787, "maximum": 697.6032, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 145.51 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 281.74, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 145.51 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 142.74 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 329.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 271.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 381.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 276.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 368.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 268.58, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 381.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 141.35 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 145.51 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 289.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 145.51 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ASSAY TEST FOR BLOOD FECAL", "code_information": [ { "code": "82274", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 79.6, "discounted_cash": 15.0, "minimum": 15.92, "maximum": 78.008, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 23.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.08, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 23.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 22.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 23.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.24, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.08, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 23.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 17.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 23.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 23.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 23.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.83, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ASTHMA - SOI : 3", "code_information": [ { "code": "1413", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6207.98, "maximum": 7123.36, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 7123.36 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6987.68 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6784.15 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 6784.15 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6919.84 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 7123.36 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 6207.98 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6784.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7123.36 } ] } ] }, { "description": "Aspirate pleura w/ imaging", "code_information": [ { "code": "32555", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4237.71, "discounted_cash": 590.0, "minimum": 590.56, "maximum": 4253.2686, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 884.07, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 590.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 738.2, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 620.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 608.28, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 856.31, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 590.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 884.07, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 620.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 826.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 884.07, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 602.37, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 856.31, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 590.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 884.07, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 649.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 884.07, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 884.07, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3267.81 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 590.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 884.07, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 590.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 590.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 590.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 590.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 631.9, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 884.07, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "Apply hand/wrist cast", "code_information": [ { "code": "29085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 403.86, "discounted_cash": 152.0, "minimum": 121.158, "maximum": 399.1834, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 191.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 157.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 221.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 160.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 214.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 156.04, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 221.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 168.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 163.69, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ASSESSMENT OF APHASIA HR", "code_information": [ { "code": "96105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 336.0, "discounted_cash": 93.0, "minimum": 93.98, "maximum": 329.28, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 140.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.06 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 245.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 117.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 238.15 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 96.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 136.27, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 238.15 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 140.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 98.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 131.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 140.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 95.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 136.27, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 242.91 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 140.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.06 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 103.38, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 140.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 140.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 250.06 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 238.15 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 93.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 140.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 238.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 93.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 93.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.06 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 100.56, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 140.69, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ATHEROSCLEROSIS WITH MCC", "code_information": [ { "code": "302", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9092.0, "minimum": 9092.24, "maximum": 18639.092, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11010.7, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9092.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11365.3, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9546.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 9365.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 13183.75, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 9092.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11010.7, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9546.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 11819.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11010.7, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 9274.08, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13183.75, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9092.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11010.7, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 14547.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 10001.46, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11010.7, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11010.7, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 16820.64, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 18639.09, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9092.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11010.7, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9092.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11018.0 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 9092.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9092.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 9728.7, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11010.7, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ASPIRATION OF BLADDER BY NEEDL", "code_information": [ { "code": "51100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 694.26, "discounted_cash": 235.0, "minimum": 208.278, "maximum": 694.26, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 294.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 242.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.05, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 246.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 329.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.05, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 258.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 694.26 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 251.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "APPLY LONG LEG CAST - BOTH", "code_information": [ { "code": "29345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 548.12, "discounted_cash": 263.0, "minimum": 138.5787, "maximum": 692.6052, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 329.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 271.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 381.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 276.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 368.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 268.58, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 381.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 289.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 281.74, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ATHEROSCLEROSIS WITHOUT MCC", "code_information": [ { "code": "303", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5545.0, "minimum": 4445.45, "maximum": 11368.275, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6715.6, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5545.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 6931.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5822.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 5711.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 8040.98, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 5545.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6715.6, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5822.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 7209.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6715.6, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 5656.41, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8040.98, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 5545.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6715.6, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 8872.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6100.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6715.6, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6715.6, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 10259.18, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 11368.28, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5545.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6715.6, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5545.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4445.45 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 5545.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5545.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 5933.69, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6715.6, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ASPIRATION OF HEMATOMA - 10160 - 45000008", "code_information": [ { "code": "10160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 932.4, "discounted_cash": 382.0, "minimum": 222.13, "maximum": 913.752, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 572.92, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 478.39, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 394.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 554.93, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 572.92, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 401.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 535.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 572.92, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 390.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 554.93, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 572.92, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 420.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 572.92, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 572.92, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 222.13 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 382.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 572.92, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 382.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 382.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 409.5, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 572.92, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "Apply short leg cast - 29435 - 51000153", "code_information": [ { "code": "29435", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 706.74, "discounted_cash": 263.0, "minimum": 138.5787, "maximum": 692.6052, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 145.51 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 142.74 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 329.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 271.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 381.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 276.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 368.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 268.58, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 381.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 141.35 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 145.51 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 289.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 145.51 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 145.51 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 281.74, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "AUD EVOKED POTENTIAL NEURODIAG", "code_information": [ { "code": "92653", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1322.25, "discounted_cash": 203.0, "minimum": 177.1786, "maximum": 1295.805, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 304.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 186.04 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 182.5 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 254.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 177.18 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 209.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 294.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 177.18 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 304.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 213.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 284.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 304.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 294.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 180.72 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 304.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 186.04 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 223.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 304.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 304.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 186.04 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 177.18 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 203.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 304.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 177.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 203.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 203.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 186.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 217.51, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 304.31, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ASPIRATION/INJECTION THYROID C", "code_information": [ { "code": "60300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1718.55, "discounted_cash": 666.0, "minimum": 506.2689, "maximum": 1684.179, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 833.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 686.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 966.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 699.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 933.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 679.99, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 966.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 733.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 506.27 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 713.33, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "AUD EVOKED POTENTIAL STATUS", "code_information": [ { "code": "92651", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 697.75, "discounted_cash": 203.0, "minimum": 177.1786, "maximum": 683.795, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 304.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 186.04 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 182.5 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 254.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 177.18 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 209.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 294.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 177.18 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 304.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 213.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 284.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 304.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 294.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 180.72 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 304.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 186.04 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 223.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 304.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 304.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 186.04 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 177.18 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 203.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 304.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 177.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 203.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 203.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 186.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 217.51, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 304.31, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ASSAY ESTRIOL LC017319", "code_information": [ { "code": "82677", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 38.0, "discounted_cash": 24.0, "minimum": 11.4, "maximum": 264.6, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.06, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 33.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.06, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 26.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.87, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.2, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ARTERIAL CATH, MONITORING", "code_information": [ { "code": "36620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1240.8, "minimum": 30.261, "maximum": 1215.984, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 494.3 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 484.88 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 470.76 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 470.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 480.18 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 494.3 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 494.3 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 470.76 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 470.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 494.3 } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY- SOI : 1", "code_information": [ { "code": "0081", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 35805.88, "maximum": 41248.33, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 41248.33 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 40462.65 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 39284.12 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 39284.12 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 40069.81 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 41248.33 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 35805.88 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 39284.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 41248.33 } ] } ] }, { "description": "ATTEN CURRENT STATUS", "code_information": [ { "code": "G9165", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2.0, "minimum": 1.0, "maximum": 2.0, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 } ] } ] }, { "description": "ASSAY IGE RESPIRATORY AREA 5", "code_information": [ { "code": "82785", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 230.65, "discounted_cash": 16.0, "minimum": 16.46, "maximum": 226.086, "payers_information": [ { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 121.12, "10th_percentile": 121.12, "90th_percentile": 121.12, "count": "1 through 10" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 8.13, "10th_percentile": 8.13, "90th_percentile": 8.13, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.87, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.87, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.64, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ARTICULAR SURFACE SIZE GREEN C", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 9772.77, "10th_percentile": 9772.77, "90th_percentile": 36144.0, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 36381.0, "10th_percentile": 36381.0, "90th_percentile": 36381.0, "count": "1 through 10" } ] } ] }, { "description": "AVUL NAIL PLT-PAR/COM SMPL SGL", "code_information": [ { "code": "11730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 589.15, "discounted_cash": 188.0, "minimum": 62.7588, "maximum": 3136.0, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 236.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 198.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 194.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 273.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 198.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 264.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 273.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 207.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 62.76 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 202.1, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ATTEN GOAL STATUS", "code_information": [ { "code": "G9166", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2.0, "minimum": 1.0, "maximum": 2.0, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 } ] } ] }, { "description": "ASTHMA - SOI : 2", "code_information": [ { "code": "1412", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5016.46, "maximum": 5749.6, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 5749.6 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5640.08 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5475.81 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 5475.81 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5585.33 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 5749.6 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 5016.46 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5475.81 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5749.6 } ] } ] }, { "description": "Aspirate/inj ganglion cyst - 20612 - 51000099", "code_information": [ { "code": "20612", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 734.1, "discounted_cash": 288.0, "minimum": 220.23, "maximum": 1914.15, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 432.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 361.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 303.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 297.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 419.01, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 432.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 303.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 404.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 432.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 419.01, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 432.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 317.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 432.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 432.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 734.1 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 432.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 309.2, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 432.59, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "B-HEXOSAMINIDASE, EA", "code_information": [ { "code": "83080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 61.0, "discounted_cash": 16.0, "minimum": 16.87, "maximum": 59.78, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.46, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.46, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY- SOI : 4", "code_information": [ { "code": "0084", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 77845.89, "maximum": 89718.46, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 89718.46 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 88009.53 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 85446.15 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 85446.15 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 87155.07 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 89718.46 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 77845.89 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 85446.15 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 89718.46 } ] } ] }, { "description": "ATOMIC ABSORPTION SPECTROSCOPY", "code_information": [ { "code": "82190", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.0, "discounted_cash": 15.0, "minimum": 15.9, "maximum": 176.4, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 23.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.06, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 23.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 22.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 23.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.06, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 23.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 17.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 23.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 23.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 23.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 15.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.01, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.8, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ASPIRATION OR INJ OF RENAL/PEL", "code_information": [ { "code": "50390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1738.02, "discounted_cash": 666.0, "minimum": 521.406, "maximum": 1738.02, "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 833.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1738.02 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 686.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 966.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1738.02 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 699.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 933.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 679.99, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 966.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1738.02 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1738.02 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 733.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 1738.02 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1738.02 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1738.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1738.02 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 713.33, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1738.02 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1738.02 } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC", "code_information": [ { "code": "519", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14537.0, "minimum": 14400.0, "maximum": 29802.3465, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17605.19, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 14537.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18172.16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15264.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 14973.83, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 21079.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 14537.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17605.19, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15264.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 18899.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17605.19, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 14828.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 21079.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 14537.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17605.19, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 23260.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 15991.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17605.19, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17605.19, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 26894.8, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 29802.35, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14537.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17605.19, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14537.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19014.7 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 14537.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14537.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 15555.37, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17605.19, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM - SOI : 1", "code_information": [ { "code": "0491", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6766.21, "maximum": 7766.97, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 7766.97 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7619.03 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7397.12 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 7397.12 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7545.06 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 7766.97 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 6766.21 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7397.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7766.97 } ] } ] }, { "description": "ATTEN D/C STATUS", "code_information": [ { "code": "G9167", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2.0, "minimum": 1.0, "maximum": 2.0, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 } ] } ] }, { "description": "ASSAY OF PHENOBARBITAL", "code_information": [ { "code": "80184", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14.75, "discounted_cash": 15.0, "minimum": 4.425, "maximum": 195.4512, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 14.75 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM - SOI : 4", "code_information": [ { "code": "0494", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 30259.54, "maximum": 34853.67, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 34853.67 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 34189.79 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 33193.97 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 33193.97 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 33857.85 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 34853.67 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 30259.54 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 33193.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 34853.67 } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC", "code_information": [ { "code": "095", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18461.0, "minimum": 18461.2, "maximum": 37845.542, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22356.56, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 18461.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 23076.55, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19384.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 19015.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 26768.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 18461.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22356.56, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19384.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 23999.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22356.56, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 18830.42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 26768.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 18461.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22356.56, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 29537.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 20307.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22356.56, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22356.56, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 34153.29, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 37845.54, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18461.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22356.56, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18461.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21733.2 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 18461.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18461.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 19753.53, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22356.56, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "AUD EVOKED POTENTIAL SCREEN", "code_information": [ { "code": "92650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 273.6, "minimum": 52.65, "maximum": 268.128, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.28 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.23 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.65 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.65 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.7 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.28 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 55.28 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 52.65 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.28 } ] } ] }, { "description": "ASTHMA - SOI : 1", "code_information": [ { "code": "1411", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4171.3, "maximum": 4775.17, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 4775.17 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4684.21 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4547.78 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 4547.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4638.73 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 4775.17 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 4171.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4547.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4775.17 } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC", "code_information": [ { "code": "094", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24832.0, "minimum": 24832.37, "maximum": 50906.3585, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30072.0, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 24832.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 31040.46, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 26074.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 25577.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 36006.94, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 24832.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30072.0, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26074.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 32282.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30072.0, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 25329.05, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 36006.94, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 24832.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30072.0, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 39731.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 27315.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30072.0, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30072.0, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 45939.88, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 50906.36, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24832.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30072.0, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24832.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28155.6 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 24832.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24832.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 26570.64, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30072.0, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "096", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18461.0, "minimum": 16618.8, "maximum": 37845.542, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22356.56, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 18461.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 23076.55, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19384.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 19015.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 26768.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 18461.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22356.56, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19384.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 23999.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22356.56, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 18830.42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 26768.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 18461.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22356.56, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 29537.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 20307.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22356.56, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22356.56, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 34153.29, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 37845.54, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18461.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22356.56, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18461.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16618.8 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 18461.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18461.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 19753.53, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22356.56, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "AUD EVOKED POTENTIAL THRESHOLD", "code_information": [ { "code": "92652", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1322.25, "discounted_cash": 203.0, "minimum": 177.1786, "maximum": 1295.805, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 304.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 186.04 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 182.5 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 254.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 177.18 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 209.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 294.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 177.18 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 304.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 213.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 284.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 304.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 294.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 180.72 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 304.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 186.04 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 223.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 304.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 304.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 186.04 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 177.18 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 203.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 304.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 177.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 203.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 203.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 186.04 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 203.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 217.51, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 304.31, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "ASTHMA - SOI : 4", "code_information": [ { "code": "1414", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8780.22, "maximum": 10089.02, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 10089.02 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 9896.85 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9608.6 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 9608.6 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9800.77 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 10089.02 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 8780.22 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9608.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10089.02 } ] } ] }, { "description": "BASIC METABOLIC WITH CALCIUM I", "code_information": [ { "code": "80047", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 154.0, "discounted_cash": 13.0, "minimum": 13.73, "maximum": 150.92, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.55, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.18 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.67 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.91, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.55, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 19.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.55, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.91, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.41 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.55, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.18 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 15.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.55, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.55, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 27.18 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 25.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.55, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.55, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CCMCC", "code_information": [ { "code": "017", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 37794.0, "minimum": 37794.87, "maximum": 77479.4835, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 45769.59, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 37794.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 47243.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 39684.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 38928.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 54802.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 37794.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 45769.59, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 39684.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 49133.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 45769.59, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 38550.8, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 54802.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 37794.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 45769.59, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 60471.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 41574.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 45769.59, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 45769.59, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 69920.51, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 77479.48, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37794.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 45769.59, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 37794.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 57166.2 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 37794.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 37794.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 40440.51, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45769.59, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "ATIVAN 2 MG/ML INJECTION", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00409677802", "type": "NDC" }, { "code": "J2060", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 3.77, "10th_percentile": 3.77, "90th_percentile": 3.77, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 4.02, "10th_percentile": 4.02, "90th_percentile": 4.02, "count": "1 through 10" } ] } ] }, { "description": "BEHAVIORAL AND DEVELOPMENTAL DISORDERS", "code_information": [ { "code": "886", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15046.0, "minimum": 10475.4, "maximum": 30845.5915, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18221.47, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 15046.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18808.29, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15798.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 15498.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 21817.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 15046.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18221.47, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15798.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 19560.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18221.47, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 15347.53, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 21817.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 15046.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18221.47, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 24074.61, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 16551.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18221.47, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18221.47, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 27836.27, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 30845.59, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15046.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18221.47, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15046.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10475.4 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 15046.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15046.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 16099.89, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18221.47, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR", "code_information": [ { "code": "518", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26308.0, "minimum": 24300.0, "maximum": 53933.327, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 31860.13, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 26308.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 32886.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 27624.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 27098.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 38147.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 26308.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 31860.13, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27624.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 34201.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 31860.13, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 26835.08, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 38147.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 26308.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 31860.13, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 42094.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 28939.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 31860.13, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 31860.13, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 48671.54, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 53933.33, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26308.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 31860.13, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26308.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28117.2 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 26308.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 26308.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 28150.57, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31860.13, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "AUG TIB 360 71X15MM RL/LM BMT", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 9772.77, "10th_percentile": 9772.77, "90th_percentile": 36144.0, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 36381.0, "10th_percentile": 36381.0, "90th_percentile": 36381.0, "count": "1 through 10" } ] } ] }, { "description": "BEHAVIORAL DISORDERS - SOI : 1", "code_information": [ { "code": "7581", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11079.59, "maximum": 14624.06, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 14624.06 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 14345.5 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 13927.67 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 13927.67 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 14206.23 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 14624.06 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 11079.59 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13927.67 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14624.06 } ] } ] }, { "description": "BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM - SOI : 3", "code_information": [ { "code": "0493", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15364.82, "maximum": 17680.76, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 17680.76 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 17343.99 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 16838.82 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 16838.82 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 17175.6 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 17680.76 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 15364.82 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 16838.82 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 17680.76 } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY- SOI : 2", "code_information": [ { "code": "0082", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 35805.88, "maximum": 41248.33, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 41248.33 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 40462.65 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 39284.12 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 39284.12 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 40069.81 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 41248.33 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 35805.88 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 39284.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 41248.33 } ] } ] }, { "description": "BENADRYL 50 MG/ML INJECTION", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00641037625", "type": "NDC" }, { "code": "J1200", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 3.77, "10th_percentile": 3.77, "90th_percentile": 3.77, "count": "13" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 4.75, "10th_percentile": 4.75, "90th_percentile": 4.75, "count": "1 through 10" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 4.55, "10th_percentile": 4.55, "90th_percentile": 4.55, "count": "1 through 10" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 54.0, "median_amount": 2.81, "10th_percentile": 2.81, "90th_percentile": 3.0, "count": "1 through 10" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 5.0, "10th_percentile": 5.0, "90th_percentile": 5.0, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 4.02, "10th_percentile": 4.01, "90th_percentile": 4.02, "count": "1 through 10" } ] } ] }, { "description": "BARTONELLA DNA, PCR", "code_information": [ { "code": "87471", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 424.0, "discounted_cash": 35.0, "minimum": 35.09, "maximum": 415.52, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.47 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.59 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.26 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.26 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.15 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.47 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 38.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 46.47 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 44.26 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.55, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BASEPLATE TIBIAL", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 9772.77, "10th_percentile": 9772.77, "90th_percentile": 36144.0, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 36381.0, "10th_percentile": 36381.0, "90th_percentile": 36381.0, "count": "1 through 10" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY- SOI : 3", "code_information": [ { "code": "0083", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 58608.86, "maximum": 67539.08, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 67539.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 66252.62 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 64322.93 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 64322.93 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 65609.39 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 67539.08 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 58608.86 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 64322.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 67539.08 } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC", "code_information": [ { "code": "726", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5876.0, "minimum": 3324.27, "maximum": 12046.169, "payers_information": [ { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7116.05, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7116.05, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 10870.93, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 12046.17, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5876.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7116.05, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5876.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3324.27 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 5876.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5876.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 6287.51, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7116.05, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7116.05, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5876.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7345.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6169.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 6052.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 8520.46, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 5876.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7116.05, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6169.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 7639.03, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7116.05, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 5993.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8520.46, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 5876.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7116.05, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 9401.89, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6463.8, "additional_payer_notes": "110.00% of Medicare Rates" } ] } ] }, { "description": "BCR/ABL1 GENE MINOR BP", "code_information": [ { "code": "81207", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 263.0, "discounted_cash": 144.0, "minimum": 78.9, "maximum": 257.74, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 216.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 160.98 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.91 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.31 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 149.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 210.02, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.31 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 216.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 152.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 202.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 216.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 147.74, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 210.02, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.38 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 216.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 160.98 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 159.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 216.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 216.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 160.98 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 153.31 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 216.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 160.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 154.98, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.83, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BASIC LIFE/OR DISABILITY EVALU", "code_information": [ { "code": "99450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.81, "minimum": 12.243, "maximum": 40.81, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.81 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.81 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.81 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.81 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.81 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.81 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 40.81 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 40.81 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.81 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.81 } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITH CCMCC", "code_information": [ { "code": "016", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 41165.0, "minimum": 41165.4, "maximum": 84389.1315, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 49851.34, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 41165.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 51456.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 43223.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 42400.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 59689.87, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 41165.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 49851.34, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43223.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 53515.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 49851.34, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 41988.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 59689.87, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 41165.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 49851.34, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 65864.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 45281.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 49851.34, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 49851.34, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 76156.05, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 84389.13, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41165.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 49851.34, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 41165.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 42858.0 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 41165.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 41165.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 44047.01, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49851.34, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "BENZODIAZEPINES", "code_information": [ { "code": "80346", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 174.0, "minimum": 4.425, "maximum": 170.52, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.63 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.84 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.44 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.63 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 41.63 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.63 } ] } ] }, { "description": "BEARING TIBIAL 14MM X 63/67", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 9772.77, "10th_percentile": 9772.77, "90th_percentile": 36144.0, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 36381.0, "10th_percentile": 36381.0, "90th_percentile": 36381.0, "count": "1 through 10" } ] } ] }, { "description": "BASIC METABOLIC PANEL", "code_information": [ { "code": "80048", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200.0, "discounted_cash": 8.0, "minimum": 8.46, "maximum": 196.0, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.18 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 3.47, "10th_percentile": 3.47, "90th_percentile": 3.47, "count": "16" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.67 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.27, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 190.0, "10th_percentile": 33.84, "90th_percentile": 190.0, "count": "15" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 182.0, "10th_percentile": 182.0, "90th_percentile": 182.0, "count": "74" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.27, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.41 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.18 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 9.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 54.0, "median_amount": 120.0, "10th_percentile": 108.0, "90th_percentile": 120.0, "count": "1 through 10" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 120.0, "10th_percentile": 120.0, "90th_percentile": 120.0, "count": "1 through 10" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 27.18 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 25.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 160.8, "10th_percentile": 160.8, "90th_percentile": 160.8, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.05, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "B CELLS TOTAL COUNT", "code_information": [ { "code": "86355", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136.0, "discounted_cash": 37.0, "minimum": 37.7253, "maximum": 133.28, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 56.48, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.62 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.86 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.73 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 38.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 54.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.73 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 56.48, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 39.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 52.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 56.48, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.48, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 54.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.48 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 56.48, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.62 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 41.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 56.48, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 56.48, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 39.62 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 37.73 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 56.48, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.62 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 40.37, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 56.48, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BICILLIN LA 1.2 MIL UNIT INJECTION", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "60793070110", "type": "NDC" }, { "code": "J0561", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 31.0, "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 233.17, "10th_percentile": 233.17, "90th_percentile": 233.17, "count": "1 through 10" } ] } ] }, { "description": "BEHAVIORAL DISORDERS - SOI : 4", "code_information": [ { "code": "7584", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 25661.58, "maximum": 34044.2, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 34044.2 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 33395.74 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 32423.05 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 32423.05 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 33071.51 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 34044.2 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 25661.58 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 32423.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 34044.2 } ] } ] }, { "description": "BEARING TIBIAL 10MM,", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 9772.77, "10th_percentile": 9772.77, "90th_percentile": 36144.0, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 36381.0, "10th_percentile": 36381.0, "90th_percentile": 36381.0, "count": "1 through 10" } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "520", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11106.0, "minimum": 9000.0, "maximum": 22769.0425, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13450.4, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11106.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13883.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11662.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 11440.11, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 16104.93, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 11106.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13450.4, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11662.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 14438.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13450.4, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 11329.04, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16104.93, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11106.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13450.4, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 17770.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 12217.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13450.4, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13450.4, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 20547.67, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 22769.04, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11106.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13450.4, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11106.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14896.9 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 11106.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11106.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 11884.33, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13450.4, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "BIOPSY BREAST ADD LESION US IM", "code_information": [ { "code": "19084", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5861.52, "minimum": 1357.8767, "maximum": 5744.2896, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3487.12 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4413.72, "10th_percentile": 4413.72, "90th_percentile": 4413.72, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3420.7 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3321.07 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3321.07 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3387.49 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3487.12 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 3487.12 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1357.88 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3321.07 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3487.12 } ] } ] }, { "description": "BEHAVRAL QUALIT ANALYS VOICE", "code_information": [ { "code": "92524", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 496.0, "discounted_cash": 105.0, "minimum": 93.0984, "maximum": 486.08, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 158.23, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 97.76 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 95.89 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 132.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.1 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 110.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 108.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 153.27, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.1 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 158.23, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 110.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 147.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 158.23, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 107.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 153.27, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 94.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 158.23, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 97.76 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 116.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 158.23, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 158.23, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 97.76 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 93.1 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 105.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 158.23, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 105.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 105.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 97.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 113.1, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 158.23, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BEARING, LG 3MM RIGHT MENISCAL", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 9772.77, "10th_percentile": 9772.77, "90th_percentile": 36144.0, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 36381.0, "10th_percentile": 36381.0, "90th_percentile": 36381.0, "count": "1 through 10" } ] } ] }, { "description": "BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM - SOI : 2", "code_information": [ { "code": "0492", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12592.44, "maximum": 14484.34, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 14484.34 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 14208.45 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 13794.61 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 13794.61 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 14070.5 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 14484.34 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 12592.44 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13794.61 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14484.34 } ] } ] }, { "description": "Biopsy of cervix", "code_information": [ { "code": "57500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1674.12, "discounted_cash": 867.0, "minimum": 502.236, "maximum": 1674.12, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1298.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 867.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1083.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 910.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 893.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1257.31, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 867.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1298.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 910.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 1213.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1298.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 884.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1257.31, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 867.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1298.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 953.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1298.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1298.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 867.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1298.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 867.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 867.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 867.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 867.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.81, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1298.06, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITH MCC", "code_information": [ { "code": "725", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8913.0, "minimum": 8913.35, "maximum": 18272.3675, "payers_information": [ { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10794.07, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10794.07, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 16489.7, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 18272.37, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8913.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10794.07, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8913.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11958.3 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 8913.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8913.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 9537.28, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10794.07, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10794.07, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8913.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11141.69, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9359.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 9180.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 12924.36, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 8913.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10794.07, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9359.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 11587.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10794.07, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 9091.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12924.36, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8913.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10794.07, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 14261.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9804.69, "additional_payer_notes": "110.00% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL VAGINOSIS NAA 180060", "code_information": [ { "code": "87798", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 250.0, "discounted_cash": 35.0, "minimum": 35.09, "maximum": 569.8896, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 38.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 54.0, "median_amount": 188.63, "10th_percentile": 188.63, "90th_percentile": 188.63, "count": "1 through 10" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 44.26 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.55, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "Biopsy of uterus lining", "code_information": [ { "code": "58100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 482.1, "discounted_cash": 190.0, "minimum": 144.63, "maximum": 482.1, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 284.91, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.1 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.1 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 237.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.1 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 199.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 196.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 275.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.1 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 284.91, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 199.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 266.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 284.91, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 194.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 275.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.1 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 284.91, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.1 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 209.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 284.91, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 284.91, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 482.1 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 482.1 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 190.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 284.91, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 190.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 190.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 482.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 203.64, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 284.91, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BENTYL 10 MG/ML INJECTION", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "58914008052", "type": "NDC" }, { "code": "J0500", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 12.05, "10th_percentile": 12.05, "90th_percentile": 12.05, "count": "1 through 10" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 16.0, "10th_percentile": 16.0, "90th_percentile": 16.0, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 12.86, "10th_percentile": 12.86, "90th_percentile": 12.86, "count": "1 through 10" } ] } ] }, { "description": "BENDING IRON FOR KIRSCHNER WIR", "code_information": [ { "code": "A4649", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 1308.65, "10th_percentile": 1308.65, "90th_percentile": 1308.65, "count": "1 through 10" } ] } ] }, { "description": "Biopsy of vagina", "code_information": [ { "code": "57100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1674.12, "discounted_cash": 867.0, "minimum": 502.236, "maximum": 1674.12, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1298.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 867.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1083.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 910.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 893.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1257.31, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 867.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1298.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 910.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 1213.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1298.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 884.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1257.31, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 867.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1298.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 953.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1298.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1298.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 867.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1298.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 867.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 867.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 867.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 867.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.81, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1298.06, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BETA-2 MICROGLOBULIN", "code_information": [ { "code": "82232", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200.0, "discounted_cash": 16.0, "minimum": 16.18, "maximum": 196.0, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.22, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.83 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.46, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.22, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.22, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.46, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.54 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.22, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 17.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.22, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.22, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.22, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.31, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.22, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BENZODIAZEPINES 13 OR MORE", "code_information": [ { "code": "80347", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200.0, "minimum": 39.6494, "maximum": 196.0, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.63 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.84 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.44 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.63 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 41.63 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.63 } ] } ] }, { "description": "BARBITURATES, OTHER", "code_information": [ { "code": "80345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34.0, "minimum": 4.425, "maximum": 34.0, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.0 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.0 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.0 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.0 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 34.0 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 34.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.0 } ] } ] }, { "description": "Biopsy of vulva/perineum - 56606 - 51000200", "code_information": [ { "code": "56606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 106.26, "minimum": 31.878, "maximum": 106.26, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 106.26 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 106.26 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 106.26 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 106.26 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 106.26 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 106.26 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 106.26 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 106.26 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 106.26 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 106.26 } ] } ] }, { "description": "BILATERAL MAMMO SCREEN", "code_information": [ { "code": "77067", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 280.76, "discounted_cash": 83.0, "minimum": 34.65, "maximum": 316.4028, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 124.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 211.42, "10th_percentile": 211.41, "90th_percentile": 211.42, "count": "99" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 104.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 85.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 120.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 266.72, "10th_percentile": 156.27, "90th_percentile": 266.72, "count": "1 through 10" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 124.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 87.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 116.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 124.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 84.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 84.93, "10th_percentile": 84.93, "90th_percentile": 84.93, "count": "19" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 120.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 124.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 91.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 124.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 124.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 54.0, "median_amount": 168.46, "10th_percentile": 151.62, "90th_percentile": 196.54, "count": "1 through 10" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 68.22 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 83.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 124.67, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 83.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 83.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 225.73, "10th_percentile": 225.73, "90th_percentile": 225.73, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 83.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 89.11, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 124.67, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BETA 2 GLYCOPROTEIN I AB, EA", "code_information": [ { "code": "86146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 202.86, "discounted_cash": 25.0, "minimum": 25.45, "maximum": 198.8028, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 26.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 35.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.23, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.1, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BARTONELLA AB", "code_information": [ { "code": "86611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.1, "discounted_cash": 10.0, "minimum": 10.18, "maximum": 92.218, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 15.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.89, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.24, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BIOPSY, THYROID", "code_information": [ { "code": "60100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1718.55, "discounted_cash": 666.0, "minimum": 506.2689, "maximum": 1703.2596, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 833.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 686.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 966.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 699.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 933.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 679.99, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 966.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 733.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 506.27 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 713.33, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC", "code_information": [ { "code": "461", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 38409.0, "minimum": 31950.0, "maximum": 78739.4545, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 46513.89, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 38409.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 48011.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 40329.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 39561.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 55693.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 38409.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 46513.89, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 40329.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 49932.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 46513.89, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 39177.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 55693.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 38409.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 46513.89, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 61455.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 42250.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 46513.89, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 46513.89, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 71057.56, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 78739.45, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38409.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 46513.89, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38409.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 58121.0 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 38409.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 38409.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 41098.15, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46513.89, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "BFB TRAINING EA ADD'L 15MIN", "code_information": [ { "code": "90913", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 101.95, "discounted_cash": 20.0, "minimum": 20.76, "maximum": 101.95, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.08, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 101.95 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 101.95 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 101.95 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.1, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 101.95 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.08, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 29.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.08, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.1, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 101.95 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.08, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 101.95 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 22.84, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.08, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.08, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 101.95 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 101.95 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.08, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 101.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 20.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 101.95 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.21, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.08, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BASEPLATE GLEN 25mm MINI TAPER", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 9772.77, "10th_percentile": 9772.77, "90th_percentile": 36144.0, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 36381.0, "10th_percentile": 36381.0, "90th_percentile": 36381.0, "count": "1 through 10" } ] } ] }, { "description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC", "code_information": [ { "code": "462", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19008.0, "minimum": 9900.0, "maximum": 38967.9785, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 23019.62, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 19008.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 23760.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19959.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 19579.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 27562.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 19008.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 23019.62, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19959.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 24711.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 23019.62, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 19388.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 27562.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 19008.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 23019.62, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 30414.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 20909.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 23019.62, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 23019.62, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 35166.22, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 38967.98, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19008.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 23019.62, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19008.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20275.8 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 19008.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 19008.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 20339.38, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23019.62, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "BILIRUBIN, FECES, QL", "code_information": [ { "code": "82252", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17.0, "discounted_cash": 4.0, "minimum": 4.56, "maximum": 16.66, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 6.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.65, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 4.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.83, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BCR/ABL1 GENE MAJOR BP", "code_information": [ { "code": "81206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1115.65, "discounted_cash": 163.0, "minimum": 153.31, "maximum": 1093.337, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 245.45, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 160.98 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.91 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 204.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.31 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 168.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 237.74, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.31 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 245.45, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 172.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 229.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 245.45, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.24, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 237.74, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.38 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 245.45, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 160.98 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 180.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 245.45, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 245.45, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 160.98 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 153.31 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 245.45, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 160.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 175.44, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 245.45, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BIPOLAR DISORDERS - SOI : 4", "code_information": [ { "code": "7534", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23694.48, "maximum": 31424.68, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 31424.68 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 30826.11 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 29928.27 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 29928.27 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 30526.83 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 31424.68 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 23694.48 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 29928.27 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 31424.68 } ] } ] }, { "description": "BILE ACIDS, CHOLYGLYCINE", "code_information": [ { "code": "82240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 96.0, "discounted_cash": 26.0, "minimum": 26.58, "maximum": 94.08, "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.28 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.46 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 27.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.54, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.46 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 39.79, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 37.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 39.79, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.54, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.01 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 39.79, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.83 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 29.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 39.79, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 39.79, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 28.83 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 27.46 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 39.79, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 26.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 28.44, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.79, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 39.79, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.83 } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "478", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17648.0, "minimum": 17007.0, "maximum": 36178.5435, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21371.81, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 17648.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 22060.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18530.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 18177.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 25589.7, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 17648.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21371.81, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18530.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 22942.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21371.81, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 18001.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 25589.7, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 17648.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21371.81, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 28236.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 19412.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21371.81, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21371.81, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 32648.93, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 36178.54, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17648.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21371.81, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17648.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17007.0 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 17648.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17648.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 18883.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21371.81, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "BEARNG PS+T10X71/75MM VANGUARD", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 9772.77, "10th_percentile": 9772.77, "90th_percentile": 36144.0, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 36381.0, "10th_percentile": 36381.0, "90th_percentile": 36381.0, "count": "1 through 10" } ] } ] }, { "description": "BLADDER INSTILLATION", "code_information": [ { "code": "51720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 688.59, "discounted_cash": 656.0, "minimum": 206.577, "maximum": 688.59, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 688.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 688.59 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 688.59 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 656.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 688.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 688.59 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 688.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 676.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 688.59, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 688.59 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 656.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 688.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 688.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 688.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 688.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 669.59, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 688.59, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 688.59 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 656.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 688.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 688.59 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 688.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 688.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 688.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 688.59 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 688.59 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 656.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 688.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 688.59 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 656.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 656.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 656.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 688.59 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 656.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 688.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 688.59, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "410", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11742.0, "minimum": 11742.48, "maximum": 24072.084, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14220.14, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11742.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14678.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12329.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 12094.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 17026.6, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 11742.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14220.14, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12329.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 15265.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14220.14, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 11977.35, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17026.6, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11742.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14220.14, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 18787.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 12916.75, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14220.14, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14220.14, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 21723.59, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 24072.08, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11742.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14220.14, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11742.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17687.1 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 11742.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11742.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 12564.45, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14220.14, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "BIOPSY BREAST 1ST LESION US IM", "code_information": [ { "code": "19083", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9628.5, "discounted_cash": 1554.0, "minimum": 960.0, "maximum": 9435.93, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 7250.26, "10th_percentile": 7250.26, "90th_percentile": 7250.26, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1943.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1632.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 1601.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2254.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1632.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 2176.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1585.97, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 8761.94, "10th_percentile": 8761.94, "90th_percentile": 8761.94, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2254.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1710.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1357.88 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1663.71, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BEHAV CHNG SMOKING 3-10 MIN", "code_information": [ { "code": "99406", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 134.2, "discounted_cash": 35.0, "minimum": 35.27, "maximum": 131.516, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.1 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 101.06, "10th_percentile": 101.05, "90th_percentile": 101.06, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 56.01 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 36.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 51.14, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 49.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 122.12, "10th_percentile": 122.12, "90th_percentile": 122.12, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 51.14, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.47 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.1 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 38.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 57.1 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 54.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 35.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 107.9, "10th_percentile": 107.9, "90th_percentile": 107.9, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.74, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.8, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BLADE HELICAL 11MM X 120MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "BILIRUBIN DIRECT", "code_information": [ { "code": "82248", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 164.4, "discounted_cash": 5.0, "minimum": 5.02, "maximum": 161.112, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 1.91, "10th_percentile": 1.91, "90th_percentile": 1.91, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 149.6, "10th_percentile": 149.6, "90th_percentile": 149.6, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 132.17, "10th_percentile": 5.02, "90th_percentile": 132.18, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.37, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "Biopsy of cervix w/scope", "code_information": [ { "code": "57455", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 805.05, "discounted_cash": 286.0, "minimum": 241.515, "maximum": 805.05, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 429.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 805.05 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 805.05 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 358.6, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 805.05 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 301.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 295.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 415.98, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 805.05 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 429.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 301.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 401.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 429.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 292.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 415.98, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 805.05 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 429.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 805.05 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 315.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 429.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 429.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 805.05 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 805.05 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 286.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 429.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 805.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 286.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 286.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 805.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 306.96, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 429.46, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BEHAVIORAL DISORDERS - SOI : 2", "code_information": [ { "code": "7582", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16067.69, "maximum": 21267.51, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 21267.51 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 20862.41 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 20254.77 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 20254.77 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 20659.86 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 21267.51 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 16067.69 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 20254.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 21267.51 } ] } ] }, { "description": "BLADE HELICAL TFNA FENES 100-S", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "BIOPSY OF SALIVARY GLAND", "code_information": [ { "code": "42400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1718.55, "discounted_cash": 666.0, "minimum": 515.565, "maximum": 1684.179, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1251.6 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1227.76 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 833.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1192.0 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 686.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 966.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1192.0 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 699.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 933.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 679.99, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 966.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1215.84 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1251.6 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 733.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 1251.6 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1192.0 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1192.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1251.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 666.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 713.33, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 997.99, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BEHAVIORAL DISORDERS - SOI : 3", "code_information": [ { "code": "7583", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 25470.03, "maximum": 33789.1, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 33789.1 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 33145.5 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 32180.09 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 32180.09 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 32823.69 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 33789.1 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 25470.03 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 32180.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 33789.1 } ] } ] }, { "description": "BLADE SPIRAL HUMERAL NAIL 34MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "BIOFEEDBACK - 90901 - 42000004", "code_information": [ { "code": "90901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 77.0, "discounted_cash": 16.0, "minimum": 16.17, "maximum": 77.0, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.0 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.45, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.0 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 22.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.49, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.45, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.0 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 77.0 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 77.0 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BIOPSY SOFT TISSUE NECK/THORAX", "code_information": [ { "code": "21550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7723.75, "discounted_cash": 1554.0, "minimum": 1554.87, "maximum": 7723.75, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7723.75 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7723.75 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1943.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7723.75 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1632.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 1601.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2254.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7723.75 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1632.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 2176.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1585.97, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2254.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7723.75 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7723.75 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1710.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 7723.75 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2266.53 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7723.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7723.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1663.71, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BENZODIAZEPINES 1-12", "code_information": [ { "code": "80346", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14.75, "minimum": 4.425, "maximum": 170.52, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 14.75 } ] } ] }, { "description": "BLADE SPIRAL HUMERAL NAIL 52MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "479", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13580.0, "minimum": 13580.2, "maximum": 27839.4715, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16445.66, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13580.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16975.29, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14259.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 13987.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 19691.33, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 13580.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16445.66, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14259.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 17654.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16445.66, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 13851.8, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 19691.33, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 13580.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16445.66, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 21728.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 14938.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16445.66, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16445.66, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 25123.43, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 27839.47, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13580.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16445.66, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13580.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14290.3 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 13580.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13580.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 14530.85, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16445.66, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "BIOPSY, MUSCLE, DEEP", "code_information": [ { "code": "20205", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6974.61, "discounted_cash": 2734.0, "minimum": 1778.2774, "maximum": 6835.1178, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4093.71, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3624.74 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3555.69 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2734.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3418.26, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3452.13 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2871.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 2816.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3965.18, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3452.13 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2734.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4093.71, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2871.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 3828.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4093.71, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2789.3, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3965.18, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3521.17 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2734.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4093.71, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3624.74 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3008.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4093.71, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4093.71, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 3624.74 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1778.28 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2734.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4093.71, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3452.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2734.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2734.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 2734.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3624.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2734.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2926.03, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4093.71, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BFB TRAINING 1ST 15MIN", "code_information": [ { "code": "90912", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 407.85, "discounted_cash": 36.0, "minimum": 36.93, "maximum": 399.693, "payers_information": [ { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 53.55, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 160.66 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.28, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 38.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 51.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.28, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.67, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 53.55, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.87 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.28, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 168.69 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 40.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.28, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.28, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 168.69 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 160.66 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 36.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.28, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 160.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 36.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 168.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39.52, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 55.28, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.28, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 168.69 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 165.48 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 160.66 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 38.04, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BLADE SPIRAL TIBIAL NAIL 65MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "Biopsy of lip", "code_information": [ { "code": "40490", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 535.5, "discounted_cash": 222.0, "minimum": 141.669, "maximum": 524.79, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 333.79, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.75 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 145.92 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 222.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 278.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 141.67 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 229.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 323.31, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 141.67 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 222.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 333.79, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 234.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 312.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 333.79, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 227.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 323.31, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.5 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 222.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 333.79, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.75 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 245.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 333.79, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 333.79, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 148.75 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 141.67 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 222.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 333.79, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 141.67 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 222.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 222.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 222.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 222.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 238.58, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 333.79, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BIOTINIDASE,EA", "code_information": [ { "code": "82261", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 197.0, "discounted_cash": 16.0, "minimum": 16.87, "maximum": 193.06, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.46, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.46, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BILE ACIDS, TOTAL", "code_information": [ { "code": "82239", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 61.0, "discounted_cash": 17.0, "minimum": 17.12, "maximum": 59.78, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 23.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.46, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.32, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.63, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BLOOD, LEUKOREDUCED, IRRADIATE", "code_information": [ { "code": "P9056", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 572.0, "discounted_cash": 84.0, "minimum": 84.14, "maximum": 560.56, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 275.16 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 84.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 84.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 84.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 288.92 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 84.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 90.03, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 125.96, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 125.96, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 288.92 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 283.41 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 84.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 105.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 275.16 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 86.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 122.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 275.16 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 84.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 125.96, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 88.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 117.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 125.96, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.82, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 122.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 280.66 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 84.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 125.96, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 288.92 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 92.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 125.96, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 125.96, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 288.92 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 275.16 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 84.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 125.96, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BIOPSY OF LIVER NEEDLE PERCUTA", "code_information": [ { "code": "47000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6877.5, "discounted_cash": 1554.0, "minimum": 1554.87, "maximum": 6739.95, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2282.96 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2239.48 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1943.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2174.25 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1632.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 1601.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2254.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2174.25 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1632.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 2176.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1585.97, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2254.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2217.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2282.96 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1710.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 2282.96 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2174.25 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2174.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2282.96 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1663.71, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BiPAP/CPAP", "code_information": [ { "code": "94660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2584.17, "discounted_cash": 206.0, "minimum": 106.8, "maximum": 2532.4866, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 308.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.14 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 1945.88, "10th_percentile": 1945.88, "90th_percentile": 1945.88, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 110.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 257.68, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 106.8 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 216.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 212.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 298.9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 106.8 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 308.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 216.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 288.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 308.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 210.26, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 298.9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 108.94 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 308.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.14 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 226.75, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 308.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 308.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 112.14 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 106.8 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 206.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 308.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 106.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 206.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 206.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 206.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 220.57, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 308.59, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC", "code_information": [ { "code": "409", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15737.0, "minimum": 15737.8, "maximum": 32262.531, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19058.5, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 15737.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 19672.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16524.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 16209.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 22819.84, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 15737.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19058.5, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16524.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 20459.17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19058.5, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 16052.56, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 22819.84, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 15737.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19058.5, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 25180.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 17311.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19058.5, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19058.5, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 29114.97, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 32262.53, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15737.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19058.5, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15737.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23117.2 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 15737.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15737.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 16839.47, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19058.5, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "BOLT LOCKING 4.9MM X 40MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "Biopsy of vulva/perineum - 56605 - 51000199", "code_information": [ { "code": "56605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1674.12, "discounted_cash": 867.0, "minimum": 502.236, "maximum": 1674.12, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1298.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 867.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1083.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 910.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 893.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1257.31, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 867.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1298.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 910.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 1213.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1298.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 884.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1257.31, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 867.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1298.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 953.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1298.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1298.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 867.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1298.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 867.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 867.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 867.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1674.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 867.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 927.81, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1298.06, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BIPOLAR CUP LINER 28 MM", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 9772.77, "10th_percentile": 9772.77, "90th_percentile": 36144.0, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 36381.0, "10th_percentile": 36381.0, "90th_percentile": 36381.0, "count": "1 through 10" } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC", "code_information": [ { "code": "408", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25145.0, "minimum": 25145.4, "maximum": 51548.152, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30451.13, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 25145.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 31431.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 26402.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 25899.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 36460.89, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 25145.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30451.13, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26402.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 32689.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30451.13, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 25648.31, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 36460.89, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25145.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30451.13, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 40232.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 27659.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30451.13, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30451.13, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 46519.06, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 51548.15, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25145.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30451.13, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25145.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 49765.1 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 25145.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 25145.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 26905.62, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30451.13, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "BOLT LOCKING 4.9MM X 42MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "BIOSURE HA SCREW 8MMX25MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "BIPOLAR DISORDERS - SOI : 2", "code_information": [ { "code": "7532", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6514.46, "maximum": 8543.99, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 8543.99 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8381.25 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8137.14 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 8137.14 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8299.88 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 8543.99 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 6514.46 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8137.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8543.99 } ] } ] }, { "description": "BILIRUBIN TOTAL", "code_information": [ { "code": "82247", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 97.11, "discounted_cash": 5.0, "minimum": 5.02, "maximum": 95.1678, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 15.78, "10th_percentile": 15.78, "90th_percentile": 15.78, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 88.37, "10th_percentile": 88.37, "90th_percentile": 88.37, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 78.08, "10th_percentile": 5.02, "90th_percentile": 78.08, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.37, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BOLT LOCKING 4.9MM X 50MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "BIPOLAR CUT SHELL 46MM", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 9772.77, "10th_percentile": 9772.77, "90th_percentile": 36144.0, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 36381.0, "10th_percentile": 36381.0, "90th_percentile": 36381.0, "count": "1 through 10" } ] } ] }, { "description": "BIPOLAR DISORDERS - SOI : 3", "code_information": [ { "code": "7533", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9439.3, "maximum": 12439.92, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 12439.92 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 12202.97 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 11847.55 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 11847.55 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12084.5 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 12439.92 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 9439.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11847.55 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12439.92 } ] } ] }, { "description": "BINOCULAR MICROSCOPY", "code_information": [ { "code": "92504", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.18, "minimum": 7.854, "maximum": 26.18, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.18 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.18 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.18 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.18 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.18 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.18 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 26.18 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 26.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.18 } ] } ] }, { "description": "BOLT LOCKING 4.9MM X 52MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "BK QNT PCR PLSMA/SER LC138962", "code_information": [ { "code": "87799", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 375.0, "discounted_cash": 42.0, "minimum": 42.84, "maximum": 590.94, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 64.13, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.47 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.59 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 53.55, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.26 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 44.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 62.12, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.26 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 64.13, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 59.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 64.13, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.7, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 62.12, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.15 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 64.13, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.47 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 47.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 64.13, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 64.13, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 46.47 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 44.26 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 64.13, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 45.84, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 64.13, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BL SMEAR W/DIFF WBC COUNT", "code_information": [ { "code": "85007", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 89.27, "discounted_cash": 3.0, "minimum": 3.8, "maximum": 87.4846, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.74 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.52 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.18 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 3.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.18 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.88, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.4 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.74 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 11.74 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 11.18 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.07, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.69, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BONE BIOPSY TROCAR/NEEDLE", "code_information": [ { "code": "20225", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4044.09, "discounted_cash": 1554.0, "minimum": 1213.227, "maximum": 3963.2082, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3624.74 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3555.69 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1943.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3452.13 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1632.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 1601.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2254.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3452.13 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1632.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 2176.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1585.97, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2254.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3521.17 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3624.74 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1710.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 3624.74 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1778.28 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3452.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3624.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1663.71, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BLADDER IRRIG, SIMPLE", "code_information": [ { "code": "51700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 688.59, "discounted_cash": 235.0, "minimum": 65.38, "maximum": 674.8182, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 294.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 242.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.05, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 246.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 329.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.05, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 258.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 65.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 251.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BLADE HELICAL 11MM X 85MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "BIOFEEDBACK - 90901 - 43001007", "code_information": [ { "code": "90901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 53.9, "discounted_cash": 16.0, "minimum": 16.17, "maximum": 77.0, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 16.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.45, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 22.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.49, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.45, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 53.9 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITHOUT MCC", "code_information": [ { "code": "554", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6608.0, "minimum": 4745.79, "maximum": 13547.8555, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8003.15, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6608.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8260.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6939.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 6806.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 9582.63, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 6608.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8003.15, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6939.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 8591.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8003.15, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 6740.88, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9582.63, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6608.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8003.15, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 10573.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7269.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8003.15, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8003.15, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 12226.11, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 13547.86, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6608.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8003.15, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6608.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4745.79 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 6608.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6608.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 7071.32, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8003.15, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "BLADE HELICAL 11MM X 105MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "BLADE HELICAL 11MM X 90MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "477", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24393.0, "minimum": 24393.26, "maximum": 50006.183, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 29540.24, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 24393.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 30491.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25612.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 25125.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 35370.23, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 24393.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 29540.24, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25612.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 31711.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 29540.24, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 24881.17, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 35370.23, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 24393.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 29540.24, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 39029.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 26832.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 29540.24, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 29540.24, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 45127.53, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 50006.18, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24393.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 29540.24, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24393.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 38114.8 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 24393.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24393.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 26100.79, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29540.24, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "BONE MARROW, SMEAR INTERP", "code_information": [ { "code": "85097", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 697.0, "discounted_cash": 758.0, "minimum": 209.1, "maximum": 697.0, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 697.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 239.22 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 234.66 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 697.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 697.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.83 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 697.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 697.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 697.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.83 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 697.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 697.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 697.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 697.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 697.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 697.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 697.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 232.39 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 697.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 697.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 239.22 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 697.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 697.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 697.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 239.22 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 227.83 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 697.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 697.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 697.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 697.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 697.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 239.22 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 697.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 697.0, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 697.0, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BLADE SPIRAL HUMERAL NAIL 38MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "BLADE SPIRAL HUMERAL NAIL 50MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "BIOPSY OF PROSTATE", "code_information": [ { "code": "55700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5087.04, "discounted_cash": 1887.0, "minimum": 1413.99, "maximum": 4985.2992, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2825.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1484.69 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1456.41 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1887.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2359.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1413.99 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1982.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 1944.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2737.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1413.99 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1887.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2825.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1982.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 2642.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2825.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1925.41, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2737.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1442.27 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1887.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2825.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1484.69 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2076.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2825.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2825.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 1484.69 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1484.39 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1887.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2825.83, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1413.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1887.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1887.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 1887.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1484.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1887.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2019.8, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2825.83, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BORRELIA AB", "code_information": [ { "code": "86619", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 49.0, "discounted_cash": 13.0, "minimum": 13.38, "maximum": 48.02, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.03, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.03, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 18.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.03, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.65, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.03, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.03, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.03, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.03, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.03, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BLADE SPIRAL HUMERAL NAIL 40MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "BLADE,48MM SPIRAL HUMERAL NAIL", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "BIOPSY, ABDOMINAL OR RETROPERI", "code_information": [ { "code": "49180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4126.5, "discounted_cash": 1554.0, "minimum": 1237.95, "maximum": 4043.97, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2282.96 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1663.71, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2282.96 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2239.48 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1943.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2174.25 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1632.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 1601.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2254.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2174.25 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1632.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 2176.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1585.97, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2254.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2217.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2282.96 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1710.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 2282.96 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2174.25 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2174.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BOWEL DISORDERS CASCADE LC", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 300.0, "discounted_cash": 11.0, "minimum": 11.53, "maximum": 404.25, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 760.95, "10th_percentile": 760.95, "90th_percentile": 760.95, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 229.9, "10th_percentile": 229.9, "90th_percentile": 919.61, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.26, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.26, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BLADE,44MM SPIRAL HUMERAL NAIL", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "BLOOD DRAW VENOUS ACCESS DVC", "code_information": [ { "code": "36591", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 545.15, "discounted_cash": 125.0, "minimum": 47.0157, "maximum": 605.2676, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.37 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.43 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 156.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.02 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 129.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.02 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 131.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 175.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.37 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 137.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 49.37 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 47.02 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.37 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BIPOLAR CUP LINER 28MM", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 9772.77, "10th_percentile": 9772.77, "90th_percentile": 36144.0, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 36381.0, "10th_percentile": 36381.0, "90th_percentile": 36381.0, "count": "1 through 10" } ] } ] }, { "description": "BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD - SOI : 2", "code_information": [ { "code": "1322", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7682.51, "maximum": 8823.43, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 8823.43 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8655.37 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8403.27 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 8403.27 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8571.34 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 8823.43 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 7682.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8403.27 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8823.43 } ] } ] }, { "description": "BLEPHAROTOMY EYELID-ABSCS", "code_information": [ { "code": "67700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 802.98, "discounted_cash": 298.0, "minimum": 240.894, "maximum": 786.9204, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 447.32, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 373.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 307.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 433.27, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 447.32, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 313.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 418.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 447.32, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 304.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 433.27, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 447.32, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 328.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 447.32, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 447.32, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 260.85 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 298.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 447.32, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 298.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 298.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 319.73, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 447.32, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BLOOD GASES ANY COMBINATION", "code_information": [ { "code": "82803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100.0, "discounted_cash": 26.0, "minimum": 26.07, "maximum": 98.0, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 39.03, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.83 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 75.3, "10th_percentile": 75.3, "90th_percentile": 75.3, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.28 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.46 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 26.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.46 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 39.03, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 36.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 39.03, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.59, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 91.0, "10th_percentile": 91.0, "90th_percentile": 91.0, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.01 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 39.03, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.83 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 28.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 39.03, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 39.03, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 54.0, "median_amount": 65.33, "10th_percentile": 65.33, "90th_percentile": 65.33, "count": "1 through 10" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 28.83 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 27.46 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 39.03, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.89, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.03, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BIPOLAR DISORDERS - SOI : 1", "code_information": [ { "code": "7531", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5869.45, "maximum": 7684.94, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 7684.94 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7538.56 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7318.99 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 7318.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7465.37 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 7684.94 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 5869.45 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7318.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7684.94 } ] } ] }, { "description": "BLOOD OCCULT PEROXIDASE", "code_information": [ { "code": "82272", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12.0, "discounted_cash": 4.0, "minimum": 3.6, "maximum": 12.0, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 9.04, "10th_percentile": 9.04, "90th_percentile": 9.04, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.29, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.0 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.13, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.0 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 11.4, "10th_percentile": 11.4, "90th_percentile": 11.4, "count": "1 through 10" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 5.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.31, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.13, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.0 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 12.0 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 12.0 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BLOOD TRANSFUSION", "code_information": [ { "code": "36430", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1940.2, "discounted_cash": 415.0, "minimum": 415.33, "maximum": 1940.2, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 621.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 519.16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 436.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 427.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 602.23, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 621.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 436.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 581.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 621.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 423.64, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 1765.58, "10th_percentile": 1765.58, "90th_percentile": 1765.58, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 602.23, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 621.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 456.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 621.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 621.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1940.2 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 415.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 621.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 415.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 415.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 444.4, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 621.75, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BLOOD PRODUCT/IRRADIATION", "code_information": [ { "code": "86945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 96.36, "discounted_cash": 35.0, "minimum": 28.908, "maximum": 94.4328, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 88.65 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 86.96 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 84.43 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 36.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.98, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 84.43 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 36.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 49.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.98, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 86.12 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 88.65 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 38.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 88.65 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 84.43 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 84.43 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 35.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 88.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.62, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.63, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BLADE 11.0MM HELICAL X 100MM S", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "BRAIN CONTUSIONLACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR NO COMA - SOI : 1", "code_information": [ { "code": "0561", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3467.65, "maximum": 3467.65, "payers_information": [ { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 3467.65 } ] } ] }, { "description": "BLOOD TYPING,ABO", "code_information": [ { "code": "86900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 279.7, "discounted_cash": 125.0, "minimum": 36.6563, "maximum": 274.106, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.49 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 210.61, "10th_percentile": 210.61, "90th_percentile": 210.61, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.76 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 156.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.66 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 129.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.66 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 131.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 175.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 254.53, "10th_percentile": 254.53, "90th_percentile": 254.53, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.39 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.49 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 137.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 38.49 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 36.66 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 224.88, "10th_percentile": 224.88, "90th_percentile": 224.88, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BLOOD SLIDE SCAN", "code_information": [ { "code": "85008", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6.0, "discounted_cash": 3.0, "minimum": 1.8, "maximum": 6.0, "payers_information": [ { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.29, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 3.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.97, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.5, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.97, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BLADE HELICAL 11MM X 110MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "BRAIN CONTUSIONLACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR NO COMA - SOI : 3", "code_information": [ { "code": "0563", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7956.94, "maximum": 7956.94, "payers_information": [ { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 7956.94 } ] } ] }, { "description": "BLOOD,LEUKOREDUCED,CMV-NEG EA", "code_information": [ { "code": "P9051", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 527.82, "discounted_cash": 150.0, "minimum": 150.84, "maximum": 517.2636, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 225.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 288.92 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 283.41 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 188.55, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 275.16 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 158.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 155.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 218.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 275.16 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 225.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 158.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 211.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 225.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 218.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 280.66 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 225.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 288.92 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 165.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 225.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 225.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 288.92 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 275.16 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 150.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 225.81, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 275.16 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 150.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 150.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 288.92 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 161.4, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 225.81, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BLOOD TYPING, RH(D)", "code_information": [ { "code": "86901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.0, "discounted_cash": 35.0, "minimum": 35.16, "maximum": 176.4, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.49 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.76 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.66 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 36.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.98, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.66 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 36.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 49.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.98, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.39 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.49 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 38.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 38.49 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 36.66 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 35.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.62, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.63, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BLADE HELICAL 11MM X 115MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "585", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14055.0, "minimum": 9900.0, "maximum": 28814.6565, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17021.73, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 14055.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 17569.91, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14758.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 14477.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 20381.1, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 14055.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17021.73, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14758.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 18272.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17021.73, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 14337.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 20381.1, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 14055.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17021.73, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 22489.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 15461.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17021.73, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17021.73, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 26003.47, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 28814.66, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14055.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17021.73, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14055.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25809.2 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 14055.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14055.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 15039.85, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17021.73, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "BODY POS D/C STATUS - G8983 - 42000048", "code_information": [ { "code": "G8983", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2.0, "minimum": 1.0, "maximum": 2.0, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 } ] } ] }, { "description": "Bone marrow biopsy", "code_information": [ { "code": "38221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4044.09, "discounted_cash": 1554.0, "minimum": 1213.227, "maximum": 4044.09, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4044.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4044.09 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1943.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4044.09 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1632.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 1601.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2254.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4044.09 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1632.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 2176.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1585.97, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2254.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4044.09 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4044.09 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1710.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 4044.09 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4044.09 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4044.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4044.09 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1663.71, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BLADE HELICAL 11MM X 80MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "BREAST PROCEDURES EXCEPT MASTECTOMY - SOI : 1", "code_information": [ { "code": "3631", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5942.94, "maximum": 6817.78, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 6817.78 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6687.92 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6493.12 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 6493.12 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6622.99 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 6817.78 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 5942.94 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6493.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6817.78 } ] } ] }, { "description": "BODY POS GOAL STATUS - G8982 - 42000047", "code_information": [ { "code": "G8982", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2.0, "minimum": 1.0, "maximum": 2.0, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2.0 } ] } ] }, { "description": "BORDETELLA PERTUSSIS AG, IFT", "code_information": [ { "code": "87265", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 11.0, "minimum": 11.98, "maximum": 43.12, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.56 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.34 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.82, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BLADE HELICAL 11MM X 95MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "BREAST PROCEDURES EXCEPT MASTECTOMY - SOI : 2", "code_information": [ { "code": "3632", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12777.73, "maximum": 14697.97, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 14697.97 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 14418.01 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 13998.07 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 13998.07 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 14278.03 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 14697.97 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 12777.73 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13998.07 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14697.97 } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITH MCC", "code_information": [ { "code": "553", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9767.0, "minimum": 9767.85, "maximum": 20024.0925, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11828.87, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9767.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12209.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10256.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 10060.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 14163.38, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 9767.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11828.87, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10256.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 12698.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11828.87, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 9963.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14163.38, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9767.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11828.87, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 15628.56, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 10744.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11828.87, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11828.87, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 18070.52, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 20024.09, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9767.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11828.87, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9767.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12369.6 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 9767.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9767.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 10451.6, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11828.87, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "BLASTOMYCES AB", "code_information": [ { "code": "86612", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 47.0, "discounted_cash": 12.0, "minimum": 12.9, "maximum": 46.06, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.8, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BREAST PROCEDURES EXCEPT MASTECTOMY - SOI : 4", "code_information": [ { "code": "3634", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20132.45, "maximum": 23177.61, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 23177.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 22736.13 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 22073.91 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 22073.91 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 22515.39 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 23177.61 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 20132.45 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 22073.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 23177.61 } ] } ] }, { "description": "BOOSTRIX VACCINE 0.5 ML VIAL", "drug_information": { "unit": 0.5, "type": "ML" }, "code_information": [ { "code": "58160084201", "type": "NDC" }, { "code": "90715", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 13.18, "10th_percentile": 13.18, "90th_percentile": 13.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 17.5, "10th_percentile": 17.5, "90th_percentile": 17.5, "count": "1 through 10" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 15.93, "10th_percentile": 15.93, "90th_percentile": 15.93, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 14.07, "10th_percentile": 14.07, "90th_percentile": 14.07, "count": "1 through 10" } ] }, { "setting": "outpatient", "minimum": 13.16, "maximum": 13.818, "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 13.18, "10th_percentile": 13.18, "90th_percentile": 13.18, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 17.5, "10th_percentile": 17.5, "90th_percentile": 17.5, "count": "1 through 10" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 15.93, "10th_percentile": 15.93, "90th_percentile": 15.93, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 14.07, "10th_percentile": 14.07, "90th_percentile": 14.07, "count": "1 through 10" } ] } ] }, { "description": "BLEEDING TIME", "code_information": [ { "code": "85002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136.0, "discounted_cash": 4.0, "minimum": 4.82, "maximum": 133.28, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.22, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.43 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.17 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.79 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.99, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.79 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.22, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 6.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.22, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.92, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.99, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.05 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.22, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.43 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.22, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.22, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 13.43 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 12.79 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.22, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 4.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.22, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BRONCHIOLITIS & RSV PNEUMONIA - SOI : 1", "code_information": [ { "code": "1381", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4412.11, "maximum": 5052.8, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 5052.8 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4956.56 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4812.2 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 4812.2 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4908.44 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 5052.8 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 4412.11 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4812.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5052.8 } ] } ] }, { "description": "BORDETELLA AB", "code_information": [ { "code": "86615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 179.7, "discounted_cash": 13.0, "minimum": 13.19, "maximum": 176.106, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.49, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.13, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 18.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.13, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BRONCHIOLITIS & RSV PNEUMONIA - SOI : 3", "code_information": [ { "code": "1383", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8749.72, "maximum": 10053.87, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 10053.87 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 9862.37 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9575.11 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 9575.11 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9766.62 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 10053.87 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 8749.72 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9575.11 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10053.87 } ] } ] }, { "description": "BLOCK FOR PAIN DENTAL OR TMJ", "code_information": [ { "code": "64400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1732.36, "discounted_cash": 288.0, "minimum": 222.732, "maximum": 1732.36, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 432.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1732.36 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1732.36 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 361.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1732.36 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 303.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 297.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 419.01, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1732.36 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 432.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 303.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 404.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 432.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 294.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 419.01, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1732.36 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 432.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1732.36 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 317.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 432.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 432.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 1732.36 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1732.36 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 432.59, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1732.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1732.36 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 288.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 309.2, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 432.59, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BRONCHIOLITIS & RSV PNEUMONIA - SOI : 2", "code_information": [ { "code": "1382", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5580.95, "maximum": 6400.42, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 6400.42 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6278.51 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6095.64 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 6095.64 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6217.55 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 6400.42 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 5580.95 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6095.64 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6400.42 } ] } ] }, { "description": "BORELLA BURGDORFERI AB", "code_information": [ { "code": "86618", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200.0, "discounted_cash": 17.0, "minimum": 17.03, "maximum": 196.0, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.49, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 8.41, "10th_percentile": 8.41, "90th_percentile": 8.41, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.29, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.69, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 190.0, "10th_percentile": 190.0, "90th_percentile": 190.0, "count": "1 through 10" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.49, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 23.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.49, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 182.0, "10th_percentile": 182.0, "90th_percentile": 182.0, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.69, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.49, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.49, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.49, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 118.08, "10th_percentile": 118.08, "90th_percentile": 118.08, "count": "1 through 10" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.49, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 160.8, "10th_percentile": 160.8, "90th_percentile": 160.8, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.22, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.49, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITH CCMCC", "code_information": [ { "code": "202", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7564.0, "minimum": 6241.55, "maximum": 15507.9425, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7564.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9161.03, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 12103.76, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8321.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9161.03, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9161.03, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 13994.97, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 15507.94, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7564.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9161.03, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7564.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6241.55 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 7564.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7564.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 8094.39, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9161.03, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9161.03, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7564.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9456.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7943.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 7791.8, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 10969.03, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 7564.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9161.03, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7943.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 9834.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9161.03, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 7716.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10969.03, "additional_payer_notes": "145.00% of Medicare Rates" } ] } ] }, { "description": "BLOOD DRAW PICC LINE", "code_information": [ { "code": "36592", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 545.15, "discounted_cash": 125.0, "minimum": 47.0157, "maximum": 534.247, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.37 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.43 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 156.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.02 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 129.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.02 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 131.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 175.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.37 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 137.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 49.37 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 47.02 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.37 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BRONCHOSPASM PROV EVAL, MULT S", "code_information": [ { "code": "94070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 756.93, "discounted_cash": 351.0, "minimum": 168.41, "maximum": 741.7914, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 525.9, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 176.83 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 173.46 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 351.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 439.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 168.41 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 368.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 361.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 509.39, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 168.41 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 351.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 525.9, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 368.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 491.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 525.9, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 358.33, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 509.39, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 171.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 351.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 525.9, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 176.83 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 386.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 525.9, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 525.9, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 176.83 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 168.41 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 351.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 525.9, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 168.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 351.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 351.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 351.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 176.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 351.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 375.89, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 525.9, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BRUCELLA AB", "code_information": [ { "code": "86622", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 239.51, "discounted_cash": 8.0, "minimum": 8.93, "maximum": 234.7198, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 9.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.56, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BLOOD GAS, PH ONLY", "code_information": [ { "code": "82800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 102.47, "discounted_cash": 11.0, "minimum": 11.0, "maximum": 100.4206, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 15.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.47, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BUR ROUND FLUTED 4.0MM", "code_information": [ { "code": "A4649", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 1308.65, "10th_percentile": 1308.65, "90th_percentile": 1308.65, "count": "1 through 10" } ] } ] }, { "description": "BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD - SOI : 3", "code_information": [ { "code": "1323", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19985.46, "maximum": 23008.14, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 23008.14 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 22569.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 21912.52 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 21912.52 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 22350.77 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 23008.14 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 19985.46 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 21912.52 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 23008.14 } ] } ] }, { "description": "BUR ROUND FLUTED 3.0MM", "code_information": [ { "code": "A4649", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 1308.65, "10th_percentile": 1308.65, "90th_percentile": 1308.65, "count": "1 through 10" } ] } ] }, { "description": "BLOOD LEUKOREDUCED, FROZEN/DEG", "code_information": [ { "code": "P9054", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 895.11, "discounted_cash": 263.0, "minimum": 263.89, "maximum": 877.2078, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 395.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 288.92 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 283.41 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 329.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 275.16 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 277.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 271.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 382.64, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 275.16 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 395.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 277.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 369.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 395.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 269.17, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 382.64, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 280.66 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 395.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 288.92 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 290.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 395.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 395.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 288.92 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 275.16 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 263.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 395.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 275.16 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 263.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 263.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 288.92 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 282.36, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 395.04, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BUR ROUND FLUTED 5.0MM", "code_information": [ { "code": "A4649", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 1308.65, "10th_percentile": 1308.65, "90th_percentile": 1308.65, "count": "1 through 10" } ] } ] }, { "description": "BURN W/O ANES MED", "code_information": [ { "code": "16025", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 529.35, "discounted_cash": 188.0, "minimum": 158.805, "maximum": 518.763, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 257.37 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 252.46 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 236.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 245.11 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 198.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 194.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 273.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 245.11 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 198.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 264.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 273.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 250.01 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 257.37 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 207.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 257.37 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 245.11 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 245.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 257.37 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 202.1, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BLOOD SMEAR,PATHOLOGIST REVIEW", "code_information": [ { "code": "85060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 77.0, "minimum": 11.1757, "maximum": 75.46, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.74 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.52 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.18 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.18 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.4 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.74 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 11.74 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 11.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.18 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.74 } ] } ] }, { "description": "BURN W/0 ANES SMALL", "code_information": [ { "code": "16020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1235.15, "discounted_cash": 188.0, "minimum": 152.055, "maximum": 3136.0, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 930.07, "10th_percentile": 930.07, "90th_percentile": 930.07, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 236.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 198.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 194.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 273.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 198.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 264.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 273.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 207.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 245.11 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 202.1, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BRADYKININ", "code_information": [ { "code": "82286", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.0, "discounted_cash": 5.0, "minimum": 5.16, "maximum": 25.48, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.72, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.45, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.48, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.72, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 7.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.72, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.48, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.72, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.72, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.72, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.72, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.52, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.72, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS - SOI : 2", "code_information": [ { "code": "8422", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23667.9, "maximum": 27253.82, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 27253.82 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 26734.7 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 25956.02 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 25956.02 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 26475.14 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 27253.82 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 23667.9 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 25956.02 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 27253.82 } ] } ] }, { "description": "BLOOD TRANSFUSION SERVICE", "code_information": [ { "code": "36430", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1940.2, "discounted_cash": 415.0, "minimum": 415.33, "maximum": 1940.2, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 621.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1940.2 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1940.2 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 519.16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1940.2 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 436.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 427.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 602.23, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1940.2 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 621.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 436.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 581.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 621.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 423.64, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 1765.58, "10th_percentile": 1765.58, "90th_percentile": 1765.58, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 602.23, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1940.2 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 621.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1940.2 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 456.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 621.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 621.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 1940.2 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1940.2 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 415.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 621.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1940.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 415.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 415.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1940.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 415.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 444.4, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 621.75, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS - SOI : 3", "code_information": [ { "code": "8423", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 40852.61, "maximum": 47066.98, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 47066.98 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 46170.47 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 44825.7 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 44825.7 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 45722.21 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 47066.98 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 40852.61 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 44825.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 47066.98 } ] } ] }, { "description": "BRAIN CONTUSIONLACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR NO COMA - SOI : 2", "code_information": [ { "code": "0562", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7956.94, "maximum": 7956.94, "payers_information": [ { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 7956.94 } ] } ] }, { "description": "BX BREAST INCISIONAL", "code_information": [ { "code": "19101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8183.52, "discounted_cash": 3686.0, "minimum": 1357.8767, "maximum": 8019.8496, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5518.17, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3487.12 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3420.7 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3686.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4607.69, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3321.07 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3870.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 3796.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5344.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3321.07 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3686.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5518.17, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3870.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 5160.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5518.17, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3759.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5344.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3387.49 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3686.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5518.17, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3487.12 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4054.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5518.17, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5518.17, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 3487.12 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1357.88 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3686.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5518.17, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3321.07 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3686.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3686.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 3686.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3487.12 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3686.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3944.18, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5518.17, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BLOOD TYPING, RBC AGS OTHER THAN ABO OR RH", "code_information": [ { "code": "86905", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 515.1, "discounted_cash": 337.0, "minimum": 36.6563, "maximum": 505.1626, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 505.16, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.49 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.76 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 337.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 421.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.66 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 354.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 347.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 489.3, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.66 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 337.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 505.16, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 354.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 472.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 505.16, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.2, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 489.3, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.39 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 337.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 505.16, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.49 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 371.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 505.16, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 505.16, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 38.49 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 36.66 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 337.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 505.16, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 337.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 337.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 337.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 337.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 361.07, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 505.16, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BV SIALIDASE ACTIVITY LC", "code_information": [ { "code": "87905", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 597.4, "discounted_cash": 12.0, "minimum": 12.22, "maximum": 585.452, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.29, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.56 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.29, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.29, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.46, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.34 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.29, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.29, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.29, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.29, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.08, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.29, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BRAIN CONTUSIONLACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR NO COMA - SOI : 4", "code_information": [ { "code": "0564", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7956.94, "maximum": 7956.94, "payers_information": [ { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 7956.94 } ] } ] }, { "description": "Bx/curett of cervix w/scope", "code_information": [ { "code": "57454", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 805.05, "discounted_cash": 286.0, "minimum": 241.515, "maximum": 805.05, "payers_information": [ { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 805.05 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 315.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 429.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 429.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 805.05 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 805.05 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 286.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 429.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 805.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 286.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 286.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 805.05 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 306.96, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 429.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 429.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 805.05 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 805.05 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 358.6, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 805.05 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 301.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 295.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 415.98, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 805.05 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 429.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 301.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 401.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 429.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 292.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 415.98, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 805.05 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 286.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 429.46, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BLOOD(WHOLE)FOR TRANS PER UNIT", "code_information": [ { "code": "P9010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 333.54, "discounted_cash": 188.0, "minimum": 100.062, "maximum": 326.8692, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 288.92 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 283.41 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 236.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 275.16 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 198.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 194.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 273.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 275.16 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 198.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 264.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 273.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 280.66 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 288.92 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 207.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 288.92 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 275.16 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 188.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 275.16 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 188.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 188.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 288.92 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 202.13, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 282.8, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BX BREAST NEEDLE CORE", "code_information": [ { "code": "19100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 681.0, "discounted_cash": 1554.0, "minimum": 204.3, "maximum": 3963.2082, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 681.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 681.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 681.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 681.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 681.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 681.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 681.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 681.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 681.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 681.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 681.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 681.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 681.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 681.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 681.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 681.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 681.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 681.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 681.0 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 681.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 681.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 681.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 681.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 681.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 681.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 681.0, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 681.0, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BRCASSURE: BRCA1/2 COMP ANAL", "code_information": [ { "code": "81162", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7500.0, "discounted_cash": 1824.0, "minimum": 884.4352, "maximum": 7350.0, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2731.85, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 928.66 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 910.97 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2281.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 884.44 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1916.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 1879.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2646.08, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 884.44 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2731.85, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1916.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 2554.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2731.85, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1861.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2646.08, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 902.13 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2731.85, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 928.66 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2007.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2731.85, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2731.85, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 928.66 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 884.44 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2731.85, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 884.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 928.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1952.62, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2731.85, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "C PEPTIDE SERUM LC 010108", "code_information": [ { "code": "84681", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18.25, "discounted_cash": 20.0, "minimum": 5.475, "maximum": 230.643, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.25 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.25 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.25 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.25 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.25 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.25 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 18.25 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 18.25 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BODY POS CURRENT STATUS - G8981 - 42000046", "code_information": [ { "code": "G8981", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2.0, "minimum": 1.0, "maximum": 2.0, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 } ] } ] }, { "description": "C-PEPTIDE", "code_information": [ { "code": "84681", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 235.35, "discounted_cash": 20.0, "minimum": 5.475, "maximum": 230.643, "payers_information": [ { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.17, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.15, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 29.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.15, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.17, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.15, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 22.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.15, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.15, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.15, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.27, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.15, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.15, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.43, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITHOUT CCMCC", "code_information": [ { "code": "203", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5523.0, "minimum": 4034.18, "maximum": 11323.8105, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6689.33, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5523.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 6904.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5800.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 5689.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 8009.52, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 5523.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6689.33, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5800.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 7180.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6689.33, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 5634.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8009.52, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 5523.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6689.33, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 8838.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6076.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6689.33, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6689.33, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 10219.05, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 11323.81, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5523.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6689.33, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5523.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4034.18 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 5523.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5523.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 5910.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6689.33, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CABLE W/CRIMP", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "BODY POS CURRENT STATUS - G8981 - 43001039", "code_information": [ { "code": "G8981", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2.0, "minimum": 1.0, "maximum": 2.0, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2.0 } ] } ] }, { "description": "C-TELOPEPTIDE, SERUM", "code_information": [ { "code": "82523", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 352.0, "discounted_cash": 18.0, "minimum": 18.68, "maximum": 344.96, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.96, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 19.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.09, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.96, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.96, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.05, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.09, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.96, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 20.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.96, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.96, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.96, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.99, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.96, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BUR ROUND FLUTED 6.0MM", "code_information": [ { "code": "A4649", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 1308.65, "10th_percentile": 1308.65, "90th_percentile": 1308.65, "count": "1 through 10" } ] } ] }, { "description": "CALCULI WITH PHOTOGRAPH LC", "code_information": [ { "code": "82365", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55.25, "discounted_cash": 12.0, "minimum": 12.9, "maximum": 54.145, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.71, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.8, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BODY POS D/C STATUS - G8983 - 43001041", "code_information": [ { "code": "G8983", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2.0, "minimum": 1.0, "maximum": 2.0, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2.0 } ] } ] }, { "description": "CA 19-9", "code_information": [ { "code": "86301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 246.0, "discounted_cash": 20.0, "minimum": 20.81, "maximum": 241.08, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.15, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.17, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.15, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 29.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.15, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.17, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.15, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 22.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.15, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.15, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.15, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.27, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.15, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS - SOI : 1", "code_information": [ { "code": "8421", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18283.41, "maximum": 21045.76, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 21045.76 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 20644.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 20043.58 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 20043.58 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 20444.45 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 21045.76 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 18283.41 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 20043.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 21045.76 } ] } ] }, { "description": "CANDIDA AB", "code_information": [ { "code": "86628", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 12.0, "minimum": 12.01, "maximum": 43.12, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.41, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 16.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.41, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.85, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BODY POS GOAL STATUS - G8982 - 43001040", "code_information": [ { "code": "G8982", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2.0, "minimum": 1.0, "maximum": 2.0, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 } ] } ] }, { "description": "CALCIFEROL (VITAMIN D)", "code_information": [ { "code": "82306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 312.5, "discounted_cash": 29.0, "minimum": 27.46, "maximum": 306.25, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 44.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.83 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 16.78, "10th_percentile": 16.78, "90th_percentile": 16.78, "count": "12" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.28 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.46 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 30.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.46 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 296.88, "10th_percentile": 59.55, "90th_percentile": 296.88, "count": "1 through 10" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 44.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 31.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 41.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 44.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.19, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 284.38, "10th_percentile": 30.19, "90th_percentile": 284.38, "count": "20" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.01 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 44.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.83 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 32.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 44.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 44.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 54.0, "median_amount": 168.75, "10th_percentile": 168.75, "90th_percentile": 187.5, "count": "1 through 10" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 28.83 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 27.46 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 44.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 251.25, "10th_percentile": 251.25, "90th_percentile": 251.25, "count": "29" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 31.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.31, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS - SOI : 4", "code_information": [ { "code": "8424", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 77251.69, "maximum": 89033.38, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 89033.38 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 87337.51 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 84793.7 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 84793.7 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 86489.57 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 89033.38 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 77251.69 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 84793.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 89033.38 } ] } ] }, { "description": "CANDIDA SKIN TEST", "code_information": [ { "code": "86485", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.55, "discounted_cash": 27.0, "minimum": 27.23, "maximum": 149.499, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.76, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 28.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.48, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.76, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 28.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 38.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.76, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.77, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.48, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.76, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 29.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.76, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.76, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.76, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 27.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 29.14, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.76, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BOLT LOCKING 4.9MM X 38", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "CALCIUM IONIZED", "code_information": [ { "code": "82330", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 269.32, "discounted_cash": 13.0, "minimum": 13.68, "maximum": 263.9336, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.48, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.84, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.48, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 19.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.48, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.84, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.48, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.48, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.48, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.48, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.64, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.48, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BWC-WORK CONDITION INITIAL 2HR - 97545 - 42100005", "code_information": [ { "code": "97545", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 855.61, "minimum": 40.93, "maximum": 838.4978, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 40.93 } ] } ] }, { "description": "CANDIDA SPECIES, APT", "code_information": [ { "code": "87481", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 327.0, "discounted_cash": 35.0, "minimum": 35.09, "maximum": 320.46, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.47 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.59 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.26 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.26 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.15 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.47 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 38.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 46.47 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 44.26 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.55, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BONE MARROW MYELOID CELLS", "code_information": [ { "code": "88237", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 848.0, "discounted_cash": 143.0, "minimum": 79.94, "maximum": 831.04, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 215.19, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 83.94 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 82.34 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 179.69, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 79.94 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 150.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 148.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 208.44, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 79.94 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 215.19, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 150.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 201.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 215.19, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 146.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 208.44, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 81.54 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 215.19, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 83.94 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 158.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 215.19, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 215.19, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 83.94 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 79.94 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 143.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 215.19, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 79.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 143.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 143.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 83.94 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 143.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 153.81, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 215.19, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CALCULUS; QL ANALYSIS", "code_information": [ { "code": "82355", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32.0, "discounted_cash": 11.0, "minimum": 9.6, "maximum": 31.36, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.79, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 16.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.79, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 11.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BWC-WORK CONDITION INITIAL 2HR - 97545 - 43001006", "code_information": [ { "code": "97545", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 445.0, "minimum": 40.93, "maximum": 838.4978, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.98 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.16 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.93 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.93 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.75 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.98 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 42.98 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 40.93 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.98 } ] } ] }, { "description": "CANNABINOIDS NATURAL QUANT", "code_information": [ { "code": "80349", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 220.0, "minimum": 39.6494, "maximum": 215.6, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.63 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.84 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.44 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.63 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 41.63 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.63 } ] } ] }, { "description": "BONE MEDICATION", "code_information": [ { "code": "A9503", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 382.01, "minimum": 114.603, "maximum": 374.3698, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 178.95 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 175.54 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 170.43 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 170.43 }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 347.63, "10th_percentile": 347.63, "90th_percentile": 347.63, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 173.84 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 178.95 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 178.95 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 170.43 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 170.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 178.95 } ] } ] }, { "description": "CAMPYLOBACTER AB", "code_information": [ { "code": "86625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 48.0, "discounted_cash": 13.0, "minimum": 13.12, "maximum": 47.04, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.02, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.02, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 13.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.64, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CABLE TITANIUM W/CRIMP 1.0MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "BONE SCREW, 6.5X30MM", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 9772.77, "10th_percentile": 9772.77, "90th_percentile": 36144.0, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 36381.0, "10th_percentile": 36381.0, "90th_percentile": 36381.0, "count": "1 through 10" } ] } ] }, { "description": "CANDIDA DNA DIR PROBE - 87480 - 30101376", "code_information": [ { "code": "87480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 72.0, "discounted_cash": 20.0, "minimum": 20.05, "maximum": 70.56, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.56 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 20.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.07, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 28.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.07, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.34 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 22.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.45, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.01, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CADMIUM", "code_information": [ { "code": "82300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 83.0, "discounted_cash": 23.0, "minimum": 21.34, "maximum": 81.34, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.41 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.98 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.55, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.34 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 24.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.34 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 33.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.77 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.41 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 26.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 22.41 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 21.34 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.29, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BONE VOID NORIAN INJECT 5CC", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "CALCITONIN", "code_information": [ { "code": "82308", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 291.92, "discounted_cash": 26.0, "minimum": 26.79, "maximum": 286.0816, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.83 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.49, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 27.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.85, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 28.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 37.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.85, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.54 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 29.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 28.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.1, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BORRELIA BURGDORFERI APT", "code_information": [ { "code": "87476", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 607.0, "discounted_cash": 35.0, "minimum": 35.09, "maximum": 594.86, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.55, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.47 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.59 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.26 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.26 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.15 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.47 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 38.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 46.47 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 44.26 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CALCIUM,TOTAL", "code_information": [ { "code": "82310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 360.0, "discounted_cash": 5.0, "minimum": 5.16, "maximum": 352.8, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.72, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.45, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.48, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.72, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 7.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.72, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.26, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.48, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.72, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.72, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.72, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.72, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.52, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.72, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CARBON DIOXIDE", "code_information": [ { "code": "82374", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 84.0, "discounted_cash": 4.0, "minimum": 4.88, "maximum": 82.32, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.08, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 6.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.98, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.08, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD - SOI : 1", "code_information": [ { "code": "1321", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5776.41, "maximum": 6625.78, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 6625.78 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6499.57 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6310.27 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 6310.27 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6436.47 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 6625.78 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 5776.41 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6310.27 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6625.78 } ] } ] }, { "description": "CALPRTECTIN, FECAL", "code_information": [ { "code": "83993", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 366.28, "discounted_cash": 19.0, "minimum": 19.63, "maximum": 358.9544, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 29.39, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.54, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 20.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.46, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 29.39, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 27.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 29.39, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 333.31, "10th_percentile": 333.31, "90th_percentile": 333.31, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.46, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 29.39, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 21.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 29.39, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 29.39, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 29.39, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.0, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.39, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITHOUT CCMCC", "code_information": [ { "code": "298", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4067.0, "minimum": 4067.57, "maximum": 8338.5185, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4925.83, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 4067.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 5084.46, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 4270.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 4189.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 5897.98, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 4067.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4925.83, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 4270.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 5287.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4925.83, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 4148.92, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 5897.98, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 4067.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4925.83, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 6508.11, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 4474.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4925.83, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4925.83, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 7525.0, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 8338.52, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 4067.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 4925.83, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 4067.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4183.5 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 4067.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 4067.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 4352.3, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 4925.83, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD - SOI : 4", "code_information": [ { "code": "1324", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 36215.56, "maximum": 41720.67, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 41720.67 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 40925.99 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 39733.97 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 39733.97 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 40528.65 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 41720.67 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 36215.56 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 39733.97 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 41720.67 } ] } ] }, { "description": "CARBON MONOXIDE QT", "code_information": [ { "code": "82375", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50.0, "discounted_cash": 12.0, "minimum": 12.32, "maximum": 49.0, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 37.65, "10th_percentile": 37.65, "90th_percentile": 37.65, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.86, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.57, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 45.5, "10th_percentile": 45.5, "90th_percentile": 45.5, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.86, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 54.0, "median_amount": 32.67, "10th_percentile": 32.67, "90th_percentile": 32.67, "count": "1 through 10" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CANNABINOID SYNTHETIC 7/MORE", "code_information": [ { "code": "80352", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200.0, "minimum": 39.6494, "maximum": 196.0, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.63 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.84 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.44 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.63 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 41.63 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.63 } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC", "code_information": [ { "code": "309", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5969.0, "minimum": 4529.92, "maximum": 12236.491, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7228.48, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5969.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7461.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6267.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 6148.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 8655.08, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 5969.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7228.48, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6267.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 7759.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7228.48, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 6088.4, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8655.08, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 5969.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7228.48, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 9550.43, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6565.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7228.48, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7228.48, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 11042.69, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 12236.49, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5969.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7228.48, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5969.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4529.92 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 5969.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5969.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 6386.85, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7228.48, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CARCINOEMBRONIC ANTIGEN (CEA)", "code_information": [ { "code": "82378", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 243.02, "discounted_cash": 18.0, "minimum": 18.96, "maximum": 238.1596, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 28.38, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.7, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 19.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.49, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 28.38, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 26.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 28.38, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.49, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 28.38, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 28.38, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 28.38, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 28.38, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.29, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.38, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CAPILLARY SPECIMEN COLLECTION", "code_information": [ { "code": "36416", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32.5, "minimum": 3.479, "maximum": 31.85, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.65 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.58 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.48 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.48 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.55 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.65 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 3.65 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3.48 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.48 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.65 } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC", "code_information": [ { "code": "308", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9142.0, "minimum": 8183.55, "maximum": 18741.8995, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11071.43, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9142.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11427.99, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9599.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 9416.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 13256.47, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 9142.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11071.43, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9599.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 11885.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11071.43, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 9325.24, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13256.47, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9142.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11071.43, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 14627.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 10056.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11071.43, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11071.43, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 16913.42, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 18741.9, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9142.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11071.43, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9142.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8183.55 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 9142.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9142.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 9782.36, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11071.43, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARREST & SHOCK - SOI : 1", "code_information": [ { "code": "1961", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5186.12, "maximum": 5945.21, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 5945.21 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5831.97 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5662.1 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 5662.1 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5775.35 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 5945.21 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 5186.12 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5662.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5945.21 } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE- SOI : 2", "code_information": [ { "code": "1912", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6487.1, "maximum": 7445.17, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 7445.17 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7303.35 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7090.64 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 7090.64 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7232.45 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 7445.17 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 6487.1 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7090.64 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7445.17 } ] } ] }, { "description": "BRAIN IMAGE W/FLOW 4+ VIEWS", "code_information": [ { "code": "78606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1366.56, "discounted_cash": 511.0, "minimum": 409.7498, "maximum": 1339.2288, "payers_information": [ { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 409.75 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 536.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 526.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 741.2, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 409.75 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 511.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 765.22, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 536.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 715.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 765.22, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 521.39, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 741.2, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 417.95 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 511.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 765.22, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 430.24 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 562.29, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 765.22, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 765.22, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 430.24 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 409.75 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 511.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 765.22, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 409.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 511.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 511.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 511.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 430.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 511.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 546.95, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 765.22, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 765.22, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 430.24 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 422.04 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 511.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 638.96, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS - SOI : 1", "code_information": [ { "code": "2011", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3819.48, "maximum": 4369.53, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 4369.53 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4286.3 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4161.46 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 4161.46 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4244.69 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 4369.53 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 3819.48 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4161.46 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4369.53 } ] } ] }, { "description": "CARBOHYDRATE DEFICIENT TRANSFE", "code_information": [ { "code": "82373", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 66.0, "discounted_cash": 18.0, "minimum": 18.06, "maximum": 64.68, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.19, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.19, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 19.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.04, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE- SOI : 3", "code_information": [ { "code": "1913", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8519.08, "maximum": 9787.95, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 9787.95 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 9601.51 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9321.86 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 9321.86 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9508.3 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 9787.95 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 8519.08 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9321.86 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9787.95 } ] } ] }, { "description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CCMCC", "code_information": [ { "code": "584", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15489.0, "minimum": 15300.0, "maximum": 31754.09, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18758.15, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 15489.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 19362.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16264.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 15954.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 22460.21, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 15489.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18758.15, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 16264.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 20136.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18758.15, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 15799.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 22460.21, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 15489.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18758.15, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 24783.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 17038.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18758.15, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18758.15, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 28656.13, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 31754.09, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15489.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18758.15, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15489.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27285.3 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 15489.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15489.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 16574.09, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18758.15, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "310", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4819.0, "minimum": 3848.17, "maximum": 9880.4875, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5836.72, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 4819.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 6024.69, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5060.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 4964.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 6988.64, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 4819.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5836.72, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5060.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 6265.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5836.72, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 4916.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 6988.64, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 4819.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5836.72, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 7711.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5301.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5836.72, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5836.72, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 8916.54, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 9880.49, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 4819.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 5836.72, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 4819.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3848.17 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 4819.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 4819.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 5157.13, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 5836.72, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CARBOXYHEMOGLOBIN", "code_information": [ { "code": "82375", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50.0, "discounted_cash": 12.0, "minimum": 12.32, "maximum": 49.0, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 37.65, "10th_percentile": 37.65, "90th_percentile": 37.65, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.86, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.57, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 45.5, "10th_percentile": 45.5, "90th_percentile": 45.5, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.86, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 54.0, "median_amount": 32.67, "10th_percentile": 32.67, "90th_percentile": 32.67, "count": "1 through 10" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS - SOI : 3", "code_information": [ { "code": "1923", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12124.9, "maximum": 13945.29, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 13945.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 13679.66 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 13281.23 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 13281.23 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 13546.85 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 13945.29 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 12124.9 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13281.23 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13945.29 } ] } ] }, { "description": "BREAST PROCEDURES EXCEPT MASTECTOMY - SOI : 3", "code_information": [ { "code": "3633", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20132.45, "maximum": 23177.61, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 23177.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 22736.13 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 22073.91 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 22073.91 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 22515.39 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 23177.61 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 20132.45 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 22073.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 23177.61 } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE- SOI : 4", "code_information": [ { "code": "1914", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12396.2, "maximum": 14258.08, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 14258.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 13986.5 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 13579.13 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 13579.13 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 13850.71 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 14258.08 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 12396.2 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13579.13 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14258.08 } ] } ] }, { "description": "CARDIAC ARREST & SHOCK - SOI : 2", "code_information": [ { "code": "1962", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5186.12, "maximum": 5945.21, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 5945.21 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5831.97 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5662.1 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 5662.1 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5775.35 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 5945.21 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 5186.12 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5662.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5945.21 } ] } ] }, { "description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC", "code_information": [ { "code": "306", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11661.0, "minimum": 11661.8, "maximum": 23906.772, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14122.49, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11661.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14577.3, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12244.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 12011.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 16909.67, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 11661.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14122.49, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12244.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 15160.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14122.49, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 11895.04, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16909.67, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11661.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14122.49, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 18658.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 12827.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14122.49, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14122.49, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 21574.4, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 23906.77, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11661.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14122.49, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11661.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14181.9 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 11661.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11661.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 12478.17, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14122.49, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "Breast reduction", "code_information": [ { "code": "19318", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21503.7, "discounted_cash": 6251.0, "minimum": 6148.7, "maximum": 21073.577, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9358.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6456.14 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 15288.65, "10th_percentile": 15288.65, "90th_percentile": 15288.65, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6333.16 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6251.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7814.16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6148.7 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6563.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 6438.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9064.43, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6148.7 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6251.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9358.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6563.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 8751.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9358.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6376.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9064.43, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6271.67 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6251.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9358.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6456.14 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6876.46, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9358.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9358.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 6456.14 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 6426.03 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6251.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9358.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6148.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6251.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6251.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 6251.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6456.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6251.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6688.92, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9358.24, "additional_payer_notes": "149.70% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 21503.65, "discounted_cash": 6251.0, "minimum": 6148.7, "maximum": 21073.577, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9358.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6456.14 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 15288.65, "10th_percentile": 15288.65, "90th_percentile": 15288.65, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6333.16 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6251.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7814.16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6148.7 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6563.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 6438.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9064.43, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6148.7 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6251.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9358.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6563.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 8751.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9358.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6376.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9064.43, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6271.67 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6251.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9358.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6456.14 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6876.46, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9358.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9358.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 6456.14 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 6426.03 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6251.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9358.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6148.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6251.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6251.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 6251.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6456.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6251.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6688.92, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9358.24, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS - SOI : 2", "code_information": [ { "code": "1922", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7877.98, "maximum": 9048.79, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 9048.79 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8876.43 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8617.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 8617.89 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8790.25 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 9048.79 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 7877.98 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8617.89 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9048.79 } ] } ] }, { "description": "CARDIAC ARREST & SHOCK - SOI : 3", "code_information": [ { "code": "1963", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6853.77, "maximum": 7867.93, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 7867.93 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7718.07 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7493.27 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 7493.27 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7643.13 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 7867.93 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 6853.77 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7493.27 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7867.93 } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH MCC", "code_information": [ { "code": "276", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 41686.0, "minimum": 27900.0, "maximum": 85457.3865, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 50482.39, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 41686.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 52108.16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 43770.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 42937.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 60445.47, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 41686.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 50482.39, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 43770.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 54192.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 50482.39, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 42520.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 60445.47, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 41686.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 50482.39, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 66698.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 45855.15, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 50482.39, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 50482.39, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 77120.08, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 85457.39, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 41686.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 50482.39, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 41686.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32146.3 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 41686.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 41686.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 44604.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 50482.39, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "BREAST SPECIMEN", "code_information": [ { "code": "76098", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1758.55, "discounted_cash": 514.0, "minimum": 187.69, "maximum": 1723.379, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 770.09, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 197.07 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 193.32 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 514.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 643.03, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 187.69 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 540.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 529.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 745.91, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 187.69 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 514.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 770.09, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 540.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 720.19, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 770.09, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 524.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 745.91, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 191.44 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 514.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 770.09, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 197.07 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 565.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 770.09, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 770.09, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 197.07 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 187.69 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 514.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 770.09, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 187.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 514.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 514.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 514.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 197.07 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 514.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 550.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 770.09, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC", "code_information": [ { "code": "275", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 49301.0, "minimum": 37350.0, "maximum": 101068.7105, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 59704.49, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 49301.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 61627.26, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 51766.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 50780.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 71487.62, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 49301.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 59704.49, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 51766.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 64092.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 59704.49, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 50287.84, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 71487.62, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 49301.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 59704.49, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 78882.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 54231.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 59704.49, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 59704.49, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 91208.35, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 101068.71, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 49301.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 59704.49, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 49301.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 55563.8 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 49301.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 49301.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 52752.94, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 59704.49, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS - SOI : 2", "code_information": [ { "code": "2012", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4556.75, "maximum": 5219.57, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 5219.57 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5120.15 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4971.02 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 4971.02 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5070.44 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 5219.57 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 4556.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4971.02 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5219.57 } ] } ] }, { "description": "CARDIAC REHAB W/O CONT MON", "code_information": [ { "code": "93797", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 354.45, "discounted_cash": 121.0, "minimum": 91.0188, "maximum": 347.361, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 181.66, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 95.57 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.75 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 151.69, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 91.02 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 124.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 175.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 91.02 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 181.66, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 127.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 169.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 181.66, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.78, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 175.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 92.84 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 181.66, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 95.57 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 133.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 181.66, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 181.66, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 95.57 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 91.02 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 121.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 181.66, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 91.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 121.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 121.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 95.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 129.84, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 181.66, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "BRONCHIOLITIS & RSV PNEUMONIA - SOI : 4", "code_information": [ { "code": "1384", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17272.5, "maximum": 19880.22, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 19880.22 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 19501.55 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 18933.55 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 18933.55 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 19312.22 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 19880.22 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 17272.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 18933.55 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 19880.22 } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC", "code_information": [ { "code": "277", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 32280.0, "minimum": 14850.0, "maximum": 66174.5535, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32280.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 45713.9 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 32280.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 32280.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 34539.89, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39091.41, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 39091.41, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 32280.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 40350.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 33894.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 33248.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 46806.39, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 32280.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 39091.41, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33894.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 41964.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 39091.41, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 32925.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 46806.39, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 32280.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 39091.41, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 51648.43, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 35508.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 39091.41, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 39091.41, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 59718.5, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 66174.55, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 32280.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 39091.41, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS - SOI : 3", "code_information": [ { "code": "2013", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6723.99, "maximum": 7718.3, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 7718.3 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7571.28 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7350.76 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 7350.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7497.77 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 7718.3 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 6723.99 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7350.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7718.3 } ] } ] }, { "description": "CARDIAC STRUCTURAL & VALVULAR DISORDERS - SOI : 4", "code_information": [ { "code": "2004", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 51122.01, "maximum": 58907.1, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 58907.1 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 57785.06 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 56102.0 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 56102.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 57224.04 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 58907.1 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 51122.01 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 56102.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 58907.1 } ] } ] }, { "description": "BUPRENORPHINE URINE LC", "code_information": [ { "code": "80307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75.0, "discounted_cash": 62.0, "minimum": 16.5, "maximum": 300.86, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 75.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 184.38, "10th_percentile": 184.38, "90th_percentile": 184.38, "count": "42" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 75.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 64.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 75.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 232.62, "10th_percentile": 232.62, "90th_percentile": 232.62, "count": "1 through 10" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 75.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 65.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 75.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 75.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 222.82, "10th_percentile": 132.22, "90th_percentile": 222.82, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 75.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 75.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 68.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 75.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 75.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 149.88, "10th_percentile": 149.88, "90th_percentile": 149.88, "count": "1 through 10" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 45.83 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 75.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 196.87, "10th_percentile": 196.87, "90th_percentile": 196.87, "count": "14" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 66.49, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 75.0, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT - SOI : 3", "code_information": [ { "code": "1773", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14045.08, "maximum": 16159.17, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 16159.17 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 15851.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 15389.69 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 15389.69 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 15697.48 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 16159.17 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 14045.08 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15389.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 16159.17 } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE- SOI : 1", "code_information": [ { "code": "1911", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5476.18, "maximum": 6279.63, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 6279.63 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6160.02 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5980.6 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 5980.6 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6100.22 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 6279.63 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 5476.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5980.6 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6279.63 } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC", "code_information": [ { "code": "220", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 37120.0, "minimum": 25200.0, "maximum": 76097.271, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 44953.07, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 37120.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 46400.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 38976.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 38234.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 53824.9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 37120.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 44953.07, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 38976.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 48256.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 44953.07, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 37863.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 53824.9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 37120.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 44953.07, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 59392.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 40832.66, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 44953.07, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 44953.07, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 68673.15, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 76097.27, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 37120.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 44953.07, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 37120.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44723.2 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 37120.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 37120.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 39719.06, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 44953.07, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "BUR DIAMOND ROUND 5.0MM", "code_information": [ { "code": "A4649", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 1308.65, "10th_percentile": 1308.65, "90th_percentile": 1308.65, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "260", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23025.0, "minimum": 23025.79, "maximum": 50412.7, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 27884.23, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 23025.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 28782.24, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 24177.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 23716.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 33387.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 23025.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 27884.23, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 24177.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 29933.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 27884.23, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 23486.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 33387.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 23025.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 27884.23, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 36841.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 25328.38, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 27884.23, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 27884.23, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 42597.71, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 47202.87, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23025.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 27884.23, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23025.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 50412.7 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 23025.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 23025.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 24637.6, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27884.23, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS - SOI : 1", "code_information": [ { "code": "1921", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6161.07, "maximum": 7069.28, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 7069.28 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6934.62 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6732.64 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 6732.64 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6867.3 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 7069.28 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 6161.07 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6732.64 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7069.28 } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CCMCC", "code_information": [ { "code": "221", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35137.0, "minimum": 13950.0, "maximum": 72032.613, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 42551.95, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 35137.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 43922.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 36894.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 36192.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 50949.9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 35137.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 42551.95, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 36894.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 45679.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 42551.95, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 35840.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 50949.9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 35137.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 42551.95, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 56220.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 38651.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 42551.95, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 42551.95, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 65005.04, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 72032.61, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35137.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 42551.95, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35137.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37230.8 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 35137.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35137.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 37597.51, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42551.95, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "Bx breast 1st lesion us imag", "code_information": [ { "code": "19083", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3200.0, "discounted_cash": 1554.0, "minimum": 960.0, "maximum": 9435.93, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3200.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3200.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1943.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3200.0 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1632.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 1601.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2254.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3200.0 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1632.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 2176.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1585.97, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2254.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3200.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3200.0 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1710.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 3200.0 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1357.88 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3200.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3200.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1554.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1663.71, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2327.64, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CCMCC", "code_information": [ { "code": "262", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12028.0, "minimum": 9000.0, "maximum": 24658.302, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14566.44, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12028.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15035.55, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12629.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 12389.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 17441.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 12028.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14566.44, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12629.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 15636.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14566.44, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 12268.97, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17441.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 12028.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14566.44, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 19245.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 13231.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14566.44, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14566.44, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 22252.61, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 24658.3, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12028.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14566.44, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12028.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14375.6 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 12028.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12028.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 12870.43, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14566.44, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS - SOI : 4", "code_information": [ { "code": "1924", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20365.43, "maximum": 23446.23, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 23446.23 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 22999.64 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 22329.75 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 22329.75 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 22776.34 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 23446.23 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 20365.43 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 22329.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 23446.23 } ] } ] }, { "description": "CARDIOMYOPATHY - SOI : 2", "code_information": [ { "code": "2052", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10072.59, "maximum": 11579.07, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 11579.07 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 11358.51 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 11027.68 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 11027.68 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 11248.24 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 11579.07 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 10072.59 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11027.68 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11579.07 } ] } ] }, { "description": "BX/RMVL AX LMPH NODE OPEN DEEP", "code_information": [ { "code": "38525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8183.52, "discounted_cash": 3686.0, "minimum": 2455.056, "maximum": 8019.8496, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5518.17, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.28 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2862.69 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3686.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4607.69, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2779.31 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3870.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 3796.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5344.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2779.31 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3686.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5518.17, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3870.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 5160.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5518.17, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3759.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5344.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2834.9 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3686.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5518.17, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.28 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4054.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5518.17, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5518.17, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 2918.28 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2977.63 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3686.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5518.17, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2779.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3686.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3686.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 3686.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2918.28 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3686.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3944.18, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5518.17, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CARDIAC REHAB W/ECG, PHASE II", "code_information": [ { "code": "93798", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 827.05, "discounted_cash": 121.0, "minimum": 91.0188, "maximum": 810.509, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 181.66, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 95.57 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 622.77, "10th_percentile": 622.77, "90th_percentile": 622.77, "count": "33" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.75 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 151.69, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 91.02 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 124.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 175.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 91.02 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 181.66, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 127.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 169.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 181.66, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.78, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 752.62, "10th_percentile": 752.62, "90th_percentile": 752.62, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 175.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 92.84 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 181.66, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 95.57 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 133.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 181.66, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 181.66, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 95.57 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 91.02 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 121.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 181.66, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 91.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 121.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 121.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 664.95, "10th_percentile": 664.93, "90th_percentile": 664.95, "count": "11" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 95.57 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 129.84, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 181.66, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT - SOI : 1", "code_information": [ { "code": "1771", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8813.05, "maximum": 10126.88, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 10126.88 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 9933.99 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9644.65 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 9644.65 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9837.55 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 10126.88 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 8813.05 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9644.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10126.88 } ] } ] }, { "description": "CARDIOMYOPATHY - SOI : 3", "code_information": [ { "code": "2053", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10072.59, "maximum": 11579.07, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 11579.07 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 11358.51 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 11027.68 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 11027.68 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 11248.24 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 11579.07 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 10072.59 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11027.68 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11579.07 } ] } ] }, { "description": "C DIFF TOXIN AMPLIFIED PROBE", "code_information": [ { "code": "87493", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 285.0, "discounted_cash": 37.0, "minimum": 37.27, "maximum": 279.3, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.79, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.47 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 214.61, "10th_percentile": 214.61, "90th_percentile": 214.61, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.59 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.26 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 38.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 54.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.26 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.79, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 39.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 52.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.79, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.02, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 259.35, "10th_percentile": 259.35, "90th_percentile": 259.35, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 54.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.15 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.79, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.47 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 41.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.79, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.79, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 46.47 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 44.26 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.79, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 229.14, "10th_percentile": 229.14, "90th_percentile": 229.14, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39.88, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 55.79, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CARDIAC STRUCTURAL & VALVULAR DISORDERS - SOI : 2", "code_information": [ { "code": "2002", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6392.49, "maximum": 7336.1, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 7336.1 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7196.36 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6986.76 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 6986.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7126.49 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 7336.1 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 6392.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6986.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7336.1 } ] } ] }, { "description": "CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT - SOI : 4", "code_information": [ { "code": "1774", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 24652.23, "maximum": 28388.71, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 28388.71 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 27847.97 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 27036.86 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 27036.86 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 27577.6 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 28388.71 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 24652.23 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 27036.86 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 28388.71 } ] } ] }, { "description": "C REACTIVE PROTEIN; HI SENS", "code_information": [ { "code": "86141", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 176.3, "discounted_cash": 12.0, "minimum": 12.95, "maximum": 172.774, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.39, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.19, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.78, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.39, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.39, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.78, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.39, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.39, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.39, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.39, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.86, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.39, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CARDIAC STRUCTURAL & VALVULAR DISORDERS - SOI : 3", "code_information": [ { "code": "2003", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12054.54, "maximum": 13864.16, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 13864.16 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 13600.08 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 13203.96 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 13203.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 13468.04 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 13864.16 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 12054.54 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13203.96 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13864.16 } ] } ] }, { "description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "258", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22275.0, "minimum": 21600.0, "maximum": 45665.0825, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 26975.81, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 22275.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 27844.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 23389.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 22943.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 32299.69, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 22275.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 26975.81, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 23389.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 28958.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 26975.81, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 22721.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 32299.69, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 22275.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 26975.81, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 35641.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 24503.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 26975.81, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 26975.81, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 41209.95, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 45665.08, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 22275.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 26975.81, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22275.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26571.1 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 22275.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 22275.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 23834.95, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26975.81, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITH MCC", "code_information": [ { "code": "034", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27212.0, "minimum": 21150.0, "maximum": 55786.4655, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36830.7 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 27212.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 27212.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 29117.81, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32954.83, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 32954.83, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 27212.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 34016.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 28573.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 28029.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 39458.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 27212.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 32954.83, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 28573.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 35376.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 32954.83, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 27757.16, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 39458.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 27212.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 32954.83, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 43540.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 29934.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 32954.83, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 32954.83, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 50343.88, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 55786.47, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 27212.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 32954.83, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27212.91, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "C-REACTIVE PROTEIN", "code_information": [ { "code": "86140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 137.33, "discounted_cash": 5.0, "minimum": 5.18, "maximum": 134.5834, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 2.45, "10th_percentile": 2.45, "90th_percentile": 2.45, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 26.21, "10th_percentile": 26.21, "90th_percentile": 26.21, "count": "1 through 10" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.28, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 124.97, "10th_percentile": 74.16, "90th_percentile": 124.97, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 54.0, "median_amount": 82.4, "10th_percentile": 82.4, "90th_percentile": 82.4, "count": "1 through 10" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 82.4, "10th_percentile": 82.4, "90th_percentile": 82.4, "count": "1 through 10" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 110.41, "10th_percentile": 5.18, "90th_percentile": 110.41, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.54, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.75, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CCMCC", "code_information": [ { "code": "218", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 45540.0, "minimum": 10350.0, "maximum": 93357.5125, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 55149.24, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 45540.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 56925.31, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 47817.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 46906.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 66033.36, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 45540.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 55149.24, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 47817.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 59202.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 55149.24, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 46451.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 66033.36, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 45540.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 55149.24, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 72864.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 50094.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 55149.24, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 55149.24, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 84249.46, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 93357.51, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45540.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 55149.24, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 45540.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 56346.2 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 45540.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 45540.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 48728.07, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 55149.24, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC", "code_information": [ { "code": "217", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 45540.0, "minimum": 23400.0, "maximum": 93357.5125, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 55149.24, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 45540.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 56925.31, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 47817.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 46906.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 66033.36, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 45540.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 55149.24, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 47817.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 59202.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 55149.24, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 46451.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 66033.36, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 45540.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 55149.24, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 72864.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 50094.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 55149.24, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 55149.24, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 84249.46, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 93357.51, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 45540.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 55149.24, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 45540.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44813.7 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 45540.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 45540.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 48728.07, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 55149.24, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CARRY CURRENT STATUS - G8984 - 43001042", "code_information": [ { "code": "G8984", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2.0, "minimum": 1.0, "maximum": 2.0, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2.0 } ] } ] }, { "description": "CA 125", "code_information": [ { "code": "86304", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 259.0, "discounted_cash": 20.0, "minimum": 20.81, "maximum": 253.82, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.15, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.17, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.15, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 29.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.15, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.17, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.15, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 22.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.15, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.15, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 31.15, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.27, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.15, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX - SOI : 3", "code_information": [ { "code": "1623", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 44045.63, "maximum": 50748.37, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 50748.37 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 49781.73 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 48331.78 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 48331.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 49298.42 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 50748.37 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 44045.63 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 48331.78 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 50748.37 } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "216", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 67275.0, "minimum": 48150.0, "maximum": 137914.611, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 81470.53, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 67275.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 84094.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 70639.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 69293.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 97549.36, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 67275.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 81470.53, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 70639.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 87458.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 81470.53, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 68620.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97549.36, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67275.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 81470.53, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 107640.67, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 74002.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 81470.53, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 81470.53, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 124459.53, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 137914.61, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 67275.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 81470.53, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 67275.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 97931.2 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 67275.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 67275.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 71984.7, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 81470.53, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CARRY D/C STATUS - G8986 - 42000051", "code_information": [ { "code": "G8986", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2.0, "minimum": 1.0, "maximum": 2.0, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 } ] } ] }, { "description": "CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX - SOI : 4", "code_information": [ { "code": "1624", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 60555.62, "maximum": 69783.61, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 69783.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 68454.39 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 66460.58 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 66460.58 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 67789.79 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 69783.61 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 60555.62 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 66460.58 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 69783.61 } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "219", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 53014.0, "minimum": 38250.0, "maximum": 108679.8685, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 64200.64, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 53014.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 66268.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 55665.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 54605.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 76871.13, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 53014.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 64200.64, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 55665.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 68918.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 64200.64, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 54074.89, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 76871.13, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 53014.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 64200.64, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 84823.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 58316.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 64200.64, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 64200.64, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 98076.95, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 108679.87, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 53014.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 64200.64, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 53014.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 64906.1 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 53014.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 53014.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 56725.59, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 64200.64, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CALCULUS; QT CHEMICAL", "code_information": [ { "code": "82360", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 42.0, "discounted_cash": 12.0, "minimum": 12.6, "maximum": 41.16, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.13, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.77, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE PROCEDURES WO AMI OR COMPLEX PDX - SOI : 3", "code_information": [ { "code": "1633", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 36519.69, "maximum": 42071.32, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 42071.32 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 41269.96 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 40067.93 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 40067.93 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 40869.29 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 42071.32 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 36519.69 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 40067.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 42071.32 } ] } ] }, { "description": "CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX - SOI : 2", "code_information": [ { "code": "1622", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 34340.72, "maximum": 39559.07, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 39559.07 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 38805.57 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 37675.31 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 37675.31 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 38428.81 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 39559.07 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 34340.72 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 37675.31 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 39559.07 } ] } ] }, { "description": "CANDIDA DNA DIR PROBE - 87510 - 30101377", "code_information": [ { "code": "87510", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 72.0, "discounted_cash": 20.0, "minimum": 20.05, "maximum": 70.56, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.56 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 20.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.07, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 28.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.07, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.34 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 22.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.45, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.01, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE PROCEDURES WO AMI OR COMPLEX PDX - SOI : 4", "code_information": [ { "code": "1634", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 61240.5, "maximum": 70573.25, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 70573.25 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 69229.0 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 67212.62 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 67212.62 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 68556.87 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 70573.25 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 61240.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 67212.62 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 70573.25 } ] } ] }, { "description": "CARDIO STRESS TEST W/ SUP, I&R", "code_information": [ { "code": "93015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 889.35, "minimum": 142.85, "maximum": 871.563, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 149.99 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 147.14 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 142.85 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 142.85 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 145.71 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 149.99 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 149.99 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 142.85 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 142.85 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 149.99 } ] } ] }, { "description": "CARDIOLIPIN AB EA IG CLASS", "code_information": [ { "code": "86147", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 214.93, "discounted_cash": 25.0, "minimum": 25.45, "maximum": 210.6314, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 26.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 35.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.9, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.23, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.1, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CARDIOMYOPATHY - SOI : 4", "code_information": [ { "code": "2054", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10072.59, "maximum": 11579.07, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 11579.07 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 11358.51 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 11027.68 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 11027.68 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 11248.24 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 11579.07 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 10072.59 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11027.68 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 11579.07 } ] } ] }, { "description": "CARDIAC ARREST & SHOCK - SOI : 4", "code_information": [ { "code": "1964", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14709.65, "maximum": 16925.38, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 16925.38 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 16602.99 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 16119.41 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 16119.41 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 16441.79 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 16925.38 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 14709.65 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 16119.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 16925.38 } ] } ] }, { "description": "CAROTENE", "code_information": [ { "code": "82380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 33.0, "discounted_cash": 9.0, "minimum": 9.22, "maximum": 32.34, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 10.14, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.87, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.8, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH CC", "code_information": [ { "code": "297", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5279.0, "minimum": 5279.86, "maximum": 10823.713, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6393.91, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5279.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 6599.83, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5543.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 5438.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 7655.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 5279.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6393.91, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5543.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 6863.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6393.91, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 5385.46, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 7655.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 5279.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6393.91, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 8447.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5807.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6393.91, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6393.91, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 9767.74, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 10823.71, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5279.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6393.91, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5279.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6671.58 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 5279.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5279.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 5649.45, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6393.91, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "Carpal tunnel surgery", "code_information": [ { "code": "64721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3323.08, "discounted_cash": 1838.0, "minimum": 996.924, "maximum": 3256.6184, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2752.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2845.69 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2791.49 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1838.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2297.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2710.18 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1930.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 1893.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2665.64, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2710.18 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1838.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2752.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1930.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 2573.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2752.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1875.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2665.64, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2764.38 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1838.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2752.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2845.69 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2022.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2752.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2752.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 2845.69 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1434.73 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1838.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2752.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2710.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1838.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1838.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 1838.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2845.69 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1838.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1967.06, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2752.04, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH MCC", "code_information": [ { "code": "296", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11567.0, "minimum": 9000.0, "maximum": 23713.6825, "payers_information": [ { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 11799.05, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16773.09, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11567.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14008.42, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 18508.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 12724.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14008.42, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14008.42, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 21400.15, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 23713.68, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11567.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14008.42, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11567.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19670.9 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 11567.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 11567.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 12377.39, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14008.42, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14008.42, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 11567.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14459.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12146.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 11914.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 16773.09, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 11567.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14008.42, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12146.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 15037.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14008.42, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CARRY GOAL STATUS - G8985 - 42000050", "code_information": [ { "code": "G8985", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2.0, "minimum": 1.0, "maximum": 2.0, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2.0 } ] } ] }, { "description": "CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS - SOI : 4", "code_information": [ { "code": "2014", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12542.4, "maximum": 14426.65, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 14426.65 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 14151.85 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 13739.66 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 13739.66 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 14014.46 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 14426.65 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 12542.4 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13739.66 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14426.65 } ] } ] }, { "description": "CATECHOLAMINES, TOTAL URINE", "code_information": [ { "code": "82382", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 266.15, "discounted_cash": 27.0, "minimum": 27.3, "maximum": 260.827, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.87, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.83 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 28.12, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.59, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.87, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 28.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 38.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.87, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.85, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.59, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.54 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.87, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 30.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.87, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.87, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 40.87, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 27.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 29.21, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.87, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC", "code_information": [ { "code": "307", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7171.0, "minimum": 7171.82, "maximum": 14702.231, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8685.07, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7171.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8964.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7530.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 7386.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 10399.14, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 7171.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8685.07, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7530.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 9323.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8685.07, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 7315.26, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10399.14, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7171.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8685.07, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 11474.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7889.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8685.07, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8685.07, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 13267.87, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 14702.23, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7171.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8685.07, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7171.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7562.38 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 7171.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7171.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 7673.85, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8685.07, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CARNITINE QT", "code_information": [ { "code": "82379", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 61.0, "discounted_cash": 16.0, "minimum": 16.87, "maximum": 59.78, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.46, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.46, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 18.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT - SOI : 2", "code_information": [ { "code": "1772", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8813.05, "maximum": 10126.88, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 10126.88 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 9933.99 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9644.65 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 9644.65 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9837.55 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 10126.88 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 8813.05 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9644.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10126.88 } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "036", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14148.0, "minimum": 5400.0, "maximum": 29004.958, "payers_information": [ { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 15139.17, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17134.15, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17134.15, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 14148.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 17685.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14856.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 14573.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 20515.7, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 14148.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17134.15, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14856.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 18393.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17134.15, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 14431.78, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 20515.7, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 14148.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17134.15, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 22638.02, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 15563.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17134.15, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17134.15, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 26175.21, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 29004.96, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14148.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17134.15, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14148.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19204.2 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 14148.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14148.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC", "code_information": [ { "code": "259", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14686.0, "minimum": 10800.0, "maximum": 30106.5665, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17784.9, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 14686.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18357.66, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15420.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 15126.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 21294.89, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 14686.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17784.9, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15420.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 19091.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17784.9, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 14979.82, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 21294.89, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 14686.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17784.9, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 23497.81, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 16154.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17784.9, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17784.9, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 27169.34, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 30106.57, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14686.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17784.9, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14686.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16647.0 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 14686.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14686.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 15714.16, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17784.9, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CATH DECLOT BY THROMB AGENT", "code_information": [ { "code": "36593", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2018.66, "discounted_cash": 310.0, "minimum": 259.542, "maximum": 1978.2868, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 465.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 407.79 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 400.02 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 310.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 388.7, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 388.37 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 326.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 320.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 450.89, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 388.37 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 310.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 465.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 326.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 435.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 465.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 317.18, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 450.89, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 396.14 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 310.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 465.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 407.79 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 342.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 465.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 465.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 407.79 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 388.37 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 310.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 465.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 388.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 310.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 310.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 310.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 407.79 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 310.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 332.73, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 465.51, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CARRY CURRENT STATUS - G8984 - 42000049", "code_information": [ { "code": "G8984", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2.0, "minimum": 1.0, "maximum": 2.0, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.0 } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC", "code_information": [ { "code": "261", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13794.0, "minimum": 13500.0, "maximum": 28278.438, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16704.97, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 13794.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 17242.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14484.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 14208.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 20001.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 13794.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16704.97, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14484.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 17932.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16704.97, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 14070.29, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 20001.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 13794.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16704.97, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 22070.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 15173.84, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16704.97, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16704.97, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 25519.57, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 28278.44, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 13794.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16704.97, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13794.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23670.1 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 13794.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 13794.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 14759.97, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16704.97, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CARRY GOAL STATUS - G8985 - 42000062", "code_information": [ { "code": "G8985", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1.0, "minimum": 1.0, "maximum": 2.0, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "CARDIAC STRUCTURAL & VALVULAR DISORDERS - SOI : 1", "code_information": [ { "code": "2001", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3702.98, "maximum": 4235.22, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 4235.22 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4154.55 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4033.54 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 4033.54 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4114.21 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 4235.22 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 3702.98 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4033.54 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4235.22 } ] } ] }, { "description": "CAST HAND", "code_information": [ { "code": "29085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 403.86, "discounted_cash": 152.0, "minimum": 121.158, "maximum": 399.1834, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 191.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 160.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 157.57, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 221.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 160.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 214.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 156.04, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 221.82, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 168.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 163.69, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 229.01, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX - SOI : 1", "code_information": [ { "code": "1621", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 24738.23, "maximum": 28487.86, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 28487.86 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 27945.23 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 27131.3 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 27131.3 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 27673.92 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 28487.86 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 24738.23 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 27131.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 28487.86 } ] } ] }, { "description": "CAST LONG LEG", "code_information": [ { "code": "29345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 706.74, "discounted_cash": 263.0, "minimum": 138.5787, "maximum": 692.6052, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 329.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 271.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 381.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 276.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 368.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 268.58, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 381.8, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 289.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 281.74, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 394.18, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CATRZTN CERVIX;ELECTRO", "code_information": [ { "code": "57510", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6818.31, "discounted_cash": 3047.0, "minimum": 2045.493, "maximum": 6818.31, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4562.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3047.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3809.45, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3199.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 3138.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4418.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3047.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4562.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3199.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 4266.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4562.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3108.51, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4418.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3047.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4562.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3352.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4562.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4562.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2242.37 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3047.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4562.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3047.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3047.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 3047.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3047.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3260.89, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4562.2, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE PROCEDURES WO AMI OR COMPLEX PDX - SOI : 1", "code_information": [ { "code": "1631", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 25614.67, "maximum": 29498.35, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 29498.35 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 28936.48 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 28093.67 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 28093.67 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 28655.54 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 29498.35 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 25614.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 28093.67 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 29498.35 } ] } ] }, { "description": "CATECHOLAMINES, BLOOD", "code_information": [ { "code": "82383", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 90.0, "discounted_cash": 29.0, "minimum": 27.0, "maximum": 88.2, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 43.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.83 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 29.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.17, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 43.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 40.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 43.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.17, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.54 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 43.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 31.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 43.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 43.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 29.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 43.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 29.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 31.12, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.53, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CEFAZOLIN SODIUM 2 GM", "drug_information": { "unit": 2.0, "type": "GR" }, "code_information": [ { "code": "60505623100", "type": "NDC" }, { "code": "J0690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 8.13, "10th_percentile": 3.77, "90th_percentile": 8.14, "count": "26" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 10.26, "10th_percentile": 10.26, "90th_percentile": 10.26, "count": "1 through 10" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 9.83, "10th_percentile": 4.55, "90th_percentile": 9.83, "count": "11" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 8.68, "10th_percentile": 4.02, "90th_percentile": 8.68, "count": "12" } ] } ] }, { "description": "CARDIAC VALVE PROCEDURES WO AMI OR COMPLEX PDX - SOI : 2", "code_information": [ { "code": "1632", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 28180.65, "maximum": 32456.8, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 32456.8 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 31838.58 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 30911.24 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 30911.24 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 31529.47 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 32456.8 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 28180.65 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 30911.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 32456.8 } ] } ] }, { "description": "CELLULITIS WITHOUT MCC", "code_information": [ { "code": "603", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6885.0, "minimum": 4873.78, "maximum": 14114.619, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8337.95, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6885.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8606.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7229.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 7091.74, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 9983.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 6885.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8337.95, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7229.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 8950.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8337.95, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 7022.88, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9983.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6885.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8337.95, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 11016.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7573.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8337.95, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8337.95, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 12737.58, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 14114.62, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6885.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8337.95, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6885.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4873.78 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 6885.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6885.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 7367.14, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8337.95, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CARDIOMYOPATHY - SOI : 1", "code_information": [ { "code": "2051", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3387.12, "maximum": 3871.05, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 3871.05 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3797.31 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3686.71 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 3686.71 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3760.45 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 3871.05 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 3387.12 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3686.71 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3871.05 } ] } ] }, { "description": "CENTRL VENOUS CATH INSRT >5 YR - 36556 - 45000486", "code_information": [ { "code": "36556", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7655.41, "discounted_cash": 2972.0, "minimum": 345.414, "maximum": 7502.3018, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4449.95, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2972.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3715.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3121.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 3061.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4310.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2972.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4449.95, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3121.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 4161.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4449.95, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3032.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4310.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2972.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4449.95, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3269.84, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4449.95, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4449.95, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 5016.92 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2972.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4449.95, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2972.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2972.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 2972.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2972.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3180.66, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4449.95, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CARDIOVERSION - 92960 - 45000358", "code_information": [ { "code": "92960", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3685.43, "discounted_cash": 622.0, "minimum": 622.24, "maximum": 3611.7214, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 931.49, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 622.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 777.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 653.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 640.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 902.25, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 622.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 931.49, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 653.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 871.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 931.49, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 634.68, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 902.25, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 622.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 931.49, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 684.46, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 931.49, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 931.49, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2410.26 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 622.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 931.49, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 622.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 622.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 622.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 622.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 665.8, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 931.49, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CENTRL VENOUS CATH INSRT >5 YR - 36556 - 76101027", "code_information": [ { "code": "36556", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7655.41, "discounted_cash": 2972.0, "minimum": 345.414, "maximum": 7502.3018, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4449.95, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2972.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3715.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3121.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 3061.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4310.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2972.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4449.95, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3121.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 4161.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4449.95, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3032.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4310.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2972.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4449.95, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3269.84, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4449.95, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4449.95, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 5016.92 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2972.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4449.95, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2972.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2972.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 2972.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2972.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3180.66, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4449.95, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CARDIOVERSION - 92960 - 76101019", "code_information": [ { "code": "92960", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3685.43, "discounted_cash": 622.0, "minimum": 622.24, "maximum": 3611.7214, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 931.49, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2530.77 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2482.57 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 622.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 777.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2410.26 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 653.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 640.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 902.25, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2410.26 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 622.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 931.49, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 653.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 871.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 931.49, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 634.68, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 902.25, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2458.47 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 622.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 931.49, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2530.77 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 684.46, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 931.49, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 931.49, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 2530.77 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2410.26 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 622.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 931.49, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2410.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 622.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 622.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 622.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2530.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 622.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 665.8, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 931.49, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CERULOPLASMIN", "code_information": [ { "code": "82390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 160.93, "discounted_cash": 10.0, "minimum": 7.035, "maximum": 157.7114, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.08, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.08, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.08, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.08, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.08, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.08, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.08, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.49, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.08, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CERV/THORAC/FACET/MEDIAL BRANC", "code_information": [ { "code": "64490", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3824.2, "discounted_cash": 832.0, "minimum": 832.67, "maximum": 3824.2, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1246.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3824.2 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 1439.81, "10th_percentile": 1439.81, "90th_percentile": 2879.63, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3824.2 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 832.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1040.84, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3824.2 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 874.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 857.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1207.37, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3824.2 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 832.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1246.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 874.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 1165.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1246.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 849.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1207.37, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3824.2 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 832.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1246.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3824.2 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 915.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1246.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1246.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 3824.2 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3824.2 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 832.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1246.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3824.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 832.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 832.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 832.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3824.2 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 832.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 890.96, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1246.51, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITH CC", "code_information": [ { "code": "035", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17182.0, "minimum": 8550.0, "maximum": 35224.207, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20808.06, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 17182.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 21478.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18041.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 17697.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 24914.68, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 17182.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20808.06, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18041.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 22337.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20808.06, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 17526.15, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 24914.68, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 17182.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20808.06, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 27492.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 18900.75, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20808.06, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20808.06, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 31787.7, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 35224.21, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17182.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20808.06, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17182.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23456.8 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 17182.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17182.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 18385.32, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20808.06, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH MCC", "code_information": [ { "code": "471", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33704.0, "minimum": 31950.0, "maximum": 69094.553, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 40816.34, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 33704.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 42130.83, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 35389.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 34715.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 48871.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 33704.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 40816.34, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35389.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 43816.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 40816.34, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 34378.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 48871.76, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33704.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 40816.34, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 53927.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 37075.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 40816.34, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 40816.34, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 62353.62, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 69094.55, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33704.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 40816.34, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33704.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37587.5 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 33704.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33704.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 36063.99, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40816.34, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CARRY CURRENT STATUS - G8984 - 42000061", "code_information": [ { "code": "G8984", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1.0, "minimum": 1.0, "maximum": 2.0, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1.0 } ] } ] }, { "description": "CERVICAL/THORAC EQIDURAL", "code_information": [ { "code": "62320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1796.43, "discounted_cash": 664.0, "minimum": 538.929, "maximum": 1796.43, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 994.82, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1796.43 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1796.43 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 664.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 830.68, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1796.43 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 697.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 684.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 963.58, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1796.43 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 664.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 994.82, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 697.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 930.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 994.82, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 677.83, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 963.58, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1796.43 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 664.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 994.82, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1796.43 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 730.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 994.82, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 994.82, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 1796.43 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1796.43 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 664.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 994.82, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1796.43 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 664.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 664.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 664.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1796.43 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 664.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 711.06, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 994.82, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CARRY D/C STATUS - G8986 - 43001044", "code_information": [ { "code": "G8986", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2.0, "minimum": 1.0, "maximum": 2.0, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2.0 } ] } ] }, { "description": "CESAREAN DELIVERY - SOI : 4", "code_information": [ { "code": "5404", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12680.0, "maximum": 16346.67, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 16346.67 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 16035.3 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 15568.25 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 15568.25 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 15879.62 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 16346.67 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 12680.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 15568.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 16346.67 } ] } ] }, { "description": "CARRY GOAL STATUS - G8985 - 43001043", "code_information": [ { "code": "G8985", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2.0, "minimum": 1.0, "maximum": 2.0, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2.0 } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION- SOI : 3", "code_information": [ { "code": "5393", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8435.43, "maximum": 10837.2, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 10837.2 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 10630.78 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 10321.14 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 10321.14 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 10527.57 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 10837.2 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 8435.43 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10321.14 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10837.2 } ] } ] }, { "description": "CARTILAGE IMP SZ 10MM CARTIVA", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "CATHEPSIN-D", "code_information": [ { "code": "82387", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 61.0, "discounted_cash": 18.0, "minimum": 18.06, "maximum": 59.78, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 18.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.19, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.42, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.19, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 19.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.04, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.04, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "Change of bladder tube", "code_information": [ { "code": "51705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 688.59, "discounted_cash": 235.0, "minimum": 65.38, "maximum": 1304.086, "payers_information": [ { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.05, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 246.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 329.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.05, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 258.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 65.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 251.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 294.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 242.27, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CATECHOLAMINES PLASMA LC084152", "code_information": [ { "code": "82384", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 101.8, "discounted_cash": 25.0, "minimum": 25.25, "maximum": 235.102, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.83 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 26.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 35.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 92.64, "10th_percentile": 92.64, "90th_percentile": 92.64, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.54 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 27.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.8, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHECKOUT ORTHOTIC/PROS EA 15MI", "code_information": [ { "code": "97763", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 91.63, "discounted_cash": 47.0, "minimum": 27.489, "maximum": 207.5836, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 70.61, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 91.63 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 91.63 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 58.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 91.63 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 48.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 91.63 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 70.61, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 49.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 66.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 70.61, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 91.63 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 70.61, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 91.63 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 51.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 70.61, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 70.61, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 91.63 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 91.63 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 47.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 70.61, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 91.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 47.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 47.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 91.63 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 50.47, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.61, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC", "code_information": [ { "code": "837", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33539.0, "minimum": 33539.3, "maximum": 68755.606, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 40616.12, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 33539.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 41924.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 35216.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 34545.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 48632.01, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 33539.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 40616.12, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 35216.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 43601.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 40616.12, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 34210.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 48632.01, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33539.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 40616.12, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 53662.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 36893.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 40616.12, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 40616.12, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 62047.74, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 68755.61, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 33539.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 40616.12, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33539.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 43412.6 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 33539.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33539.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 35887.07, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40616.12, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT", "code_information": [ { "code": "838", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15128.0, "minimum": 13267.2, "maximum": 31013.671, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18320.76, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 15128.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18910.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15885.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 15582.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 21936.5, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 15128.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18320.76, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15885.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 19667.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18320.76, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 15431.17, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 21936.5, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 15128.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18320.76, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 24205.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 16641.46, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18320.76, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18320.76, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 27987.95, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 31013.67, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15128.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18320.76, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15128.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13267.2 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 15128.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15128.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 16187.62, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18320.76, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CAURZTN WOUND CHEMICAL", "code_information": [ { "code": "17250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 506.85, "discounted_cash": 188.0, "minimum": 152.055, "maximum": 496.713, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 233.24 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 228.79 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 236.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 222.13 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 198.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 194.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 273.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 222.13 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 198.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 264.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 273.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 226.57 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 233.24 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 207.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 233.24 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 222.13 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 222.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 233.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 202.1, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "839", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10768.0, "minimum": 8775.7, "maximum": 22074.482, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13040.1, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10768.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13460.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11306.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 11091.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 15613.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 10768.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13040.1, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11306.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 13998.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13040.1, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 10983.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15613.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10768.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13040.1, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 17228.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 11844.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13040.1, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13040.1, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 19920.87, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 22074.48, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10768.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13040.1, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10768.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8775.7 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 10768.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10768.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 11521.8, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13040.1, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "848", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6739.0, "minimum": 6218.51, "maximum": 13815.9545, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8161.52, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6739.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8424.36, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7076.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 6941.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 9772.26, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 6739.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8161.52, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7076.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 8761.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8161.52, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 6874.28, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9772.26, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6739.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8161.52, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 10783.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7413.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8161.52, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8161.52, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 12468.06, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 13815.95, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6739.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8161.52, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6739.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6218.51 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 6739.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6739.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 7211.25, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8161.52, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CHEST PAIN - SOI : 3", "code_information": [ { "code": "2033", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6219.71, "maximum": 7136.88, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 7136.88 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7000.94 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6797.03 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 6797.03 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6932.97 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 7136.88 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 6219.71 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6797.03 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7136.88 } ] } ] }, { "description": "CEHMILUMINESCENT ASSAY", "code_information": [ { "code": "82397", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 51.0, "discounted_cash": 14.0, "minimum": 14.12, "maximum": 49.98, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.14, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 14.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.47, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.14, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 19.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.14, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.4, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 46.41, "10th_percentile": 46.41, "90th_percentile": 46.41, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.47, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.14, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 15.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.14, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.14, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 21.14, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.11, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.14, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CATHETER FOR HYSTEROGRAPHY", "code_information": [ { "code": "58340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 806.33, "minimum": 107.9087, "maximum": 790.2034, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.31 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 111.15 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 107.91 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 107.91 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 110.07 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.31 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 113.31 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 107.91 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 107.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.31 } ] } ] }, { "description": "CHEST TUBE INSERT/REMOVE", "code_information": [ { "code": "32551", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2948.91, "discounted_cash": 1481.0, "minimum": 884.673, "maximum": 2948.91, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1481.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1481.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 1481.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1481.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1585.71, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2218.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2218.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1481.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1852.46, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1556.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 1526.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2148.86, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1481.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2218.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1556.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 2074.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2218.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1511.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2148.86, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1481.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2218.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1630.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2218.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2218.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2948.91 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1481.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2218.51, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CELL COUNT,BODY FLUID", "code_information": [ { "code": "89050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 157.0, "discounted_cash": 4.0, "minimum": 4.72, "maximum": 153.86, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.07, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.15 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.8 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.84, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.8 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.07, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.07, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.84, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.04 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.07, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.07, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.07, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 11.8 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.07, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.05, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.07, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES", "code_information": [ { "code": "018", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 293605.0, "minimum": 55350.0, "maximum": 601891.9925, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 355556.68, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 293606.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 367007.31, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 308286.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 302414.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 425728.48, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 293606.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 355556.68, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 308286.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 381687.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 355556.68, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 299478.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 425728.48, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 293606.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 355556.68, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 469769.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 322966.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 355556.68, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 355556.68, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 543170.82, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 601891.99, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 293606.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 355556.68, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 293605.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 309922.0 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 293605.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 293606.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 314158.26, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 355556.68, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CELLULITIS & OTHER SKIN INFECTIONS - SOI : 1", "code_information": [ { "code": "3831", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4113.45, "maximum": 4708.46, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 4708.46 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4618.78 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4484.25 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 4484.25 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4573.94 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 4708.46 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 4113.45 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4484.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4708.46 } ] } ] }, { "description": "CHIPS CANCELLOUS 15 1-8MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "CELLULITIS & OTHER SKIN INFECTIONS - SOI : 3", "code_information": [ { "code": "3833", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7358.84, "maximum": 8450.25, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 8450.25 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8289.29 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8047.86 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 8047.86 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8208.81 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 8450.25 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 7358.84 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8047.86 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8450.25 } ] } ] }, { "description": "CHLAMYDIA ABS IGG", "code_information": [ { "code": "86631", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 42.0, "discounted_cash": 11.0, "minimum": 11.82, "maximum": 41.16, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 16.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.69, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CELLULITIS & OTHER SKIN INFECTIONS - SOI : 4", "code_information": [ { "code": "3834", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12735.51, "maximum": 14649.3, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 14649.3 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 14370.26 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 13951.71 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 13951.71 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 14230.75 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 14649.3 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 12735.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 13951.71 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 14649.3 } ] } ] }, { "description": "CATHRZN BLADDER COMPLEX", "code_information": [ { "code": "51703", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 680.0, "discounted_cash": 121.0, "minimum": 65.38, "maximum": 666.4, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 181.33, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.65 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.34 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 151.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 124.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 175.64, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 181.33, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 169.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 181.33, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.55, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 175.64, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66.69 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 181.33, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.65 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 133.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 181.33, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 181.33, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 68.65 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 65.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 121.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 181.33, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 121.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 121.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 129.61, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 181.33, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHLAMYDIA TRACHOMATIS NAA", "code_information": [ { "code": "87491", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 320.0, "discounted_cash": 35.0, "minimum": 17.325, "maximum": 313.6, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.47 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 19.88, "10th_percentile": 19.88, "90th_percentile": 19.88, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.59 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.26 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.26 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 304.0, "10th_percentile": 304.0, "90th_percentile": 304.0, "count": "1 through 10" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 291.2, "10th_percentile": 63.7, "90th_percentile": 291.2, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.15 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.47 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 38.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 54.0, "median_amount": 80.48, "10th_percentile": 80.48, "90th_percentile": 80.48, "count": "1 through 10" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 46.47 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 44.26 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 257.28, "10th_percentile": 257.28, "90th_percentile": 257.28, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.47 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.55, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CEREBYX 50 MG PE/ML INJECTION", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00069600102", "type": "NDC" }, { "code": "Q2009", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 1.0, "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 297.96, "10th_percentile": 297.96, "90th_percentile": 297.96, "count": "1 through 10" } ] } ] }, { "description": "CAUTERIZATION, INNER NOSE", "code_information": [ { "code": "30801", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3414.24, "discounted_cash": 1460.0, "minimum": 1024.272, "maximum": 3345.9552, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2186.7, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1594.38 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1564.01 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1460.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1825.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1518.46 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1533.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 1504.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2118.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1518.46 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1460.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2186.7, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1533.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 2045.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2186.7, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1489.93, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2118.04, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1548.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1460.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2186.7, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1594.38 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1606.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2186.7, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2186.7, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 1594.38 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1236.58 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1460.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2186.7, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1518.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1460.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1460.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 1460.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1594.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1460.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1562.97, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2186.7, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHLORIDE, OTHER SOURCE", "code_information": [ { "code": "82438", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18.0, "discounted_cash": 5.0, "minimum": 5.0, "maximum": 17.64, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.49, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.49, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 7.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.49, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.49, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.49, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.49, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 7.49, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.35, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.49, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CERULOPLASMIN LC001560", "code_information": [ { "code": "82390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23.45, "discounted_cash": 10.0, "minimum": 7.035, "maximum": 157.7114, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.08, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.08, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.08, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.08, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.08, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.08, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.08, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 11.49, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.08, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CBC, NO AUTO DIFFERENTIAL", "code_information": [ { "code": "85027", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 182.45, "discounted_cash": 6.0, "minimum": 6.47, "maximum": 178.801, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.74 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 3.06, "10th_percentile": 3.06, "90th_percentile": 3.06, "count": "12" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.52 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.18 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.18 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 23.5, "10th_percentile": 11.4, "90th_percentile": 173.33, "count": "1 through 10" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 9.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 166.03, "10th_percentile": 98.52, "90th_percentile": 166.03, "count": "32" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.4 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.74 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 7.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 54.0, "median_amount": 109.47, "10th_percentile": 98.52, "90th_percentile": 109.47, "count": "1 through 10" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 109.47, "10th_percentile": 109.47, "90th_percentile": 109.47, "count": "1 through 10" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 11.74 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 11.18 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 9.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 146.69, "10th_percentile": 146.69, "90th_percentile": 146.69, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.92, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.69, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHOLE TEC KIT", "code_information": [ { "code": "A4641", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 140.91, "minimum": 26.565, "maximum": 807.422, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 140.91 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 140.91 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 140.91 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 140.91 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 140.91 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 140.91 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 140.91 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 140.91 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 140.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 140.91 } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH CC", "code_information": [ { "code": "472", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20947.0, "minimum": 11250.0, "maximum": 42942.334, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25367.4, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 20947.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 26184.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 21994.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 21575.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 30373.85, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 20947.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25367.4, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 21994.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 27231.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25367.4, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 21366.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 30373.85, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 20947.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25367.4, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 33515.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 23042.25, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25367.4, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25367.4, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 38752.84, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 42942.33, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 20947.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25367.4, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20947.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23527.6 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 20947.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 20947.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 22413.8, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25367.4, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CCP ANTIBODY IGG/IGA LC", "code_information": [ { "code": "86200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71.85, "discounted_cash": 12.0, "minimum": 12.95, "maximum": 140.14, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.39, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 6.39, "10th_percentile": 6.39, "90th_percentile": 6.39, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.19, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.78, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.39, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.39, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.21, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 130.13, "10th_percentile": 130.13, "90th_percentile": 130.13, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.78, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.39, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.39, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.39, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 85.8, "10th_percentile": 85.8, "90th_percentile": 85.8, "count": "1 through 10" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 19.39, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.86, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.39, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITH CC", "code_information": [ { "code": "412", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15230.0, "minimum": 15230.95, "maximum": 31223.4475, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18444.68, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 15231.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 19038.69, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15992.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 15687.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 22084.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 15231.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18444.68, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15992.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 19800.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18444.68, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 15535.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 22084.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 15231.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18444.68, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 24369.52, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 16754.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18444.68, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18444.68, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 28177.26, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 31223.45, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15231.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18444.68, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15230.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20188.8 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 15230.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 15231.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 16297.12, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18444.68, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CESAREAN DELIVERY - SOI : 1", "code_information": [ { "code": "5401", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5236.94, "maximum": 6685.27, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 6685.27 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6557.93 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6366.93 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 6366.93 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6494.26 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 6685.27 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 5236.94 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6366.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6685.27 } ] } ] }, { "description": "CELLULITIS WITH MCC", "code_information": [ { "code": "602", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10614.0, "minimum": 10614.89, "maximum": 21760.5245, "payers_information": [ { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12854.63, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 16983.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 11676.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12854.63, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12854.63, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 19637.55, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 21760.52, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10614.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12854.63, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10614.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10829.5 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 10614.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10614.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 11357.93, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12854.63, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12854.63, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10614.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13268.61, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11145.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 10933.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 15391.59, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 10614.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12854.63, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 11145.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 13799.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12854.63, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 10827.2, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15391.59, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10614.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "413", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12235.0, "minimum": 12235.8, "maximum": 25083.39, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14817.55, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12235.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15294.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12847.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 12602.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 17741.91, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 12235.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14817.55, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12847.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 15906.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14817.55, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 12480.52, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17741.91, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 12235.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14817.55, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 19577.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 13459.38, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14817.55, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14817.55, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 22636.23, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 25083.39, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12235.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14817.55, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12235.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15745.9 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 12235.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12235.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 13092.31, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14817.55, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITH MCC", "code_information": [ { "code": "783", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17620.0, "minimum": 7540.0, "maximum": 36121.5945, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21338.17, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 17620.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 22025.36, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18501.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 18148.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 25549.42, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 17620.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21338.17, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18501.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 22906.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21338.17, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 17972.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 25549.42, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 17620.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21338.17, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 7540.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 19382.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21338.17, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21338.17, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 32597.54, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 36121.59, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17620.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21338.17, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17620.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12420.0 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 17620.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17620.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 18853.71, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21338.17, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CENTRAL AUDI FUNCTION 60 MIN", "code_information": [ { "code": "92620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 407.85, "discounted_cash": 121.0, "minimum": 93.0984, "maximum": 399.693, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 181.33, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 97.76 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 95.89 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 151.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.1 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 124.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 175.64, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.1 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 181.33, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 127.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 169.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 181.33, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 123.55, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 175.64, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 94.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 181.33, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 97.76 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 133.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 181.33, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 181.33, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 97.76 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 93.1 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 121.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 181.33, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 93.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 121.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 121.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 97.76 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 129.61, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 181.33, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY- SOI : 1", "code_information": [ { "code": "2631", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6996.85, "maximum": 8032.89, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 8032.89 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7879.88 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7650.37 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 7650.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7803.38 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 8032.89 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 6996.85 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7650.37 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8032.89 } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "785", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7474.0, "minimum": 6501.78, "maximum": 15321.8025, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9051.07, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7474.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9342.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7847.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 7698.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 10837.37, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 7474.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9051.07, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7847.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 9716.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9051.07, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 7623.53, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10837.37, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7474.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9051.07, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 7540.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8221.46, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9051.07, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9051.07, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 13826.99, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 15321.8, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7474.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9051.07, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7474.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6501.78 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 7474.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7474.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 7997.23, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9051.07, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CENTRAL LINE LESS THAN 5 YRS", "code_information": [ { "code": "36555", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2948.91, "discounted_cash": 2972.0, "minimum": 884.673, "maximum": 2948.91, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2948.91 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2948.91 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2948.91 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2948.91 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2948.91 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2948.91 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 2948.91 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2948.91 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2948.91 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2948.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2948.91, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY- SOI : 3", "code_information": [ { "code": "2633", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10916.19, "maximum": 12551.7, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 12551.7 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 12312.62 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 11954.0 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 11954.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12193.08 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 12551.7 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 10916.19 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 11954.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 12551.7 } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION- SOI : 2", "code_information": [ { "code": "5392", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6134.49, "maximum": 7849.9, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 7849.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7700.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7476.1 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 7476.1 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7625.62 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 7849.9 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 6134.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7476.1 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7849.9 } ] } ] }, { "description": "CERV/THORAC TRANSFORAMIAL EPID", "code_information": [ { "code": "64479", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2294.52, "discounted_cash": 832.0, "minimum": 688.356, "maximum": 2294.52, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1246.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2294.52 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2294.52 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 832.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1040.84, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2294.52 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 874.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 857.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1207.37, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2294.52 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 832.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1246.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 874.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 1165.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1246.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 849.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1207.37, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2294.52 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 832.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1246.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2294.52 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 915.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1246.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1246.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 2294.52 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2294.52 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 832.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1246.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2294.52 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 832.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 832.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 832.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2294.52 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 832.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 890.96, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1246.51, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHANGE CYSTOSTOMY TUBE SIMPLE", "code_information": [ { "code": "51705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1330.7, "discounted_cash": 235.0, "minimum": 65.38, "maximum": 1304.086, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 294.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 242.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.05, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 246.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 329.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.05, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 258.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 65.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 251.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CESAREAN DELIVERY - SOI : 2", "code_information": [ { "code": "5402", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6262.7, "maximum": 8016.67, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 8016.67 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 7863.97 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7634.92 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 7634.92 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 7787.62 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 8016.67 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 6262.7 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7634.92 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8016.67 } ] } ] }, { "description": "CHOLESTEROL TOTAL", "code_information": [ { "code": "82465", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 216.98, "discounted_cash": 4.0, "minimum": 4.35, "maximum": 212.6404, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 197.45, "10th_percentile": 197.45, "90th_percentile": 197.45, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 4.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.31, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 6.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.44, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 197.45, "10th_percentile": 197.45, "90th_percentile": 197.45, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.31, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 4.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 4.65, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHEMODENERVATION SPHINCTER", "code_information": [ { "code": "46505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5184.8, "discounted_cash": 1126.0, "minimum": 584.75, "maximum": 5081.104, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1686.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 613.99 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 602.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1126.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1408.2, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 584.75 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1182.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 1160.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1633.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 584.75 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1126.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1686.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1182.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 1577.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1686.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1149.09, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1633.51, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 596.45 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1126.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1686.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 613.99 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1239.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1686.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1686.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 613.99 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1431.11 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1126.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1686.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 584.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1126.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1126.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 1126.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 613.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1126.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1205.42, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1686.46, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION- SOI : 1", "code_information": [ { "code": "5391", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5548.12, "maximum": 7089.11, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 7089.11 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6954.08 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6751.53 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 6751.53 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6886.56 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 7089.11 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 5548.12 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6751.53 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 7089.11 } ] } ] }, { "description": "CHOLINESTERASE, SERUM", "code_information": [ { "code": "82480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29.0, "discounted_cash": 7.0, "minimum": 7.87, "maximum": 28.42, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.78, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.84, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.11, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.41, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.78, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 11.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.78, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.41, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.78, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 8.66, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.78, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.78, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.78, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.42, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.78, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CATHETERIZE FOR URINE SPEC", "code_information": [ { "code": "P9612", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 140.72, "discounted_cash": 9.0, "minimum": 3.479, "maximum": 137.9056, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.65 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.58 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.48 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.48 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 13.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.53, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.55 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.65 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 10.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 3.65 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 3.48 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 13.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 9.99, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.98, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY FOR ACUTE LEUKEMIA - SOI : 2", "code_information": [ { "code": "6952", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8267.33, "maximum": 9497.7, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 9497.7 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 9316.79 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9045.42 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 9045.42 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9226.33 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 9497.7 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 8267.33 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9045.42 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9497.7 } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH MCC", "code_information": [ { "code": "786", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12161.0, "minimum": 7540.0, "maximum": 24930.583, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14727.29, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 12161.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15201.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12769.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 12526.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 17633.83, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 12161.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14727.29, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12769.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 15809.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14727.29, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 12404.53, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17633.83, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 12161.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14727.29, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 7540.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 13377.43, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14727.29, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14727.29, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 22498.33, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 24930.58, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 12161.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14727.29, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12161.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 12161.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 12161.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 13012.55, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14727.29, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CHONDROITIN B SULFATE, QT", "code_information": [ { "code": "82485", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 74.0, "discounted_cash": 20.0, "minimum": 20.65, "maximum": 72.52, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 22.1, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.91, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.91, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.83 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 21.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.94, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.91, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 28.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.91, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.06, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.94, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.54 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.91, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 22.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.91, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.91, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.91, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 20.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.41 } ] } ] }, { "description": "Cauterization of cervix", "code_information": [ { "code": "57510", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6818.31, "discounted_cash": 3047.0, "minimum": 2045.493, "maximum": 6818.31, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4562.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6818.31 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6818.31 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3047.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3809.45, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6818.31 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3199.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 3138.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4418.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6818.31 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3047.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4562.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3199.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 4266.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4562.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3108.51, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4418.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6818.31 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3047.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4562.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6818.31 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3352.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4562.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4562.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 6818.31 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2242.37 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3047.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 4562.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6818.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3047.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3047.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 3047.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6818.31 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3047.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3260.89, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4562.2, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY FOR ACUTE LEUKEMIA - SOI : 3", "code_information": [ { "code": "6953", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21814.96, "maximum": 25117.46, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 25117.46 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 24639.03 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 23921.39 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 23921.39 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 24399.82 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 25117.46 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 21814.96 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 23921.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 25117.46 } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "788", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7480.0, "minimum": 7480.82, "maximum": 15335.681, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9059.27, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 7480.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9351.03, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7854.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 7705.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 10847.19, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 7480.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9059.27, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7854.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 9725.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9059.27, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 7630.44, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10847.19, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7480.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9059.27, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 7540.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8228.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9059.27, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9059.27, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 13839.52, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 15335.68, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7480.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9059.27, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7480.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8477.06 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 7480.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 7480.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 8004.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9059.27, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CHROM ANA, ADDL HIGH RES", "code_information": [ { "code": "88289", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 123.0, "discounted_cash": 34.0, "minimum": 34.43, "maximum": 120.54, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 51.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.99 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.78 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 110.47 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 35.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 110.47 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 51.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 36.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 48.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 51.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.12, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.68 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 51.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.99 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 37.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 51.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 51.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 115.99 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 110.47 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 34.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 51.54, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 110.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 34.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 34.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 51.54, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CBC,COMPLETE AUTO DIFFERENTIAL", "code_information": [ { "code": "85025", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 150.0, "discounted_cash": 7.0, "minimum": 7.77, "maximum": 147.0, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.74 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 3.68, "10th_percentile": 3.68, "90th_percentile": 3.68, "count": "37" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.52 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.18 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 8.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.27, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.18 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 142.5, "10th_percentile": 21.15, "90th_percentile": 142.5, "count": "38" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 10.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.93, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 136.5, "10th_percentile": 116.82, "90th_percentile": 136.5, "count": "185" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.27, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.4 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.74 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 8.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 54.0, "median_amount": 90.0, "10th_percentile": 82.57, "90th_percentile": 90.0, "count": "14" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "percent of total billed charges", "standard_charge_percentage": 60.0, "median_amount": 70.75, "10th_percentile": 70.75, "90th_percentile": 70.75, "count": "1 through 10" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 11.74 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 11.18 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 120.6, "10th_percentile": 120.6, "90th_percentile": 120.6, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 8.31, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC", "code_information": [ { "code": "846", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18551.0, "minimum": 13305.6, "maximum": 38030.288, "payers_information": [ { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 24116.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22465.7, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 18922.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 26899.47, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 18551.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22465.7, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 29682.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 20406.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22465.7, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22465.7, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 34320.02, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 38030.29, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18551.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22465.7, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18551.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13305.6 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 18551.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 18551.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 19849.96, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22465.7, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22465.7, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 18551.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 23189.2, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19478.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 19107.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 26899.47, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 18551.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22465.7, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 19478.97, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "CHANGE NEPHROSTOMY/PYELOMY TUB", "code_information": [ { "code": "50435", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5219.25, "discounted_cash": 1967.0, "minimum": 1321.7063, "maximum": 5219.25, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2946.05, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5219.25 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5219.25 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1967.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2459.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5219.25 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2066.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 2027.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2853.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5219.25 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1967.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2946.05, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2066.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 2755.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2946.05, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2007.33, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2853.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5219.25 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1967.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2946.05, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5219.25 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2164.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2946.05, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2946.05, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 5219.25 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1321.71 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1967.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2946.05, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5219.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1967.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1967.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 1967.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5219.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1967.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2105.73, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2946.05, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHROMO ANAL; BASE; 50-100 CELL", "code_information": [ { "code": "88248", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 621.0, "discounted_cash": 173.0, "minimum": 153.31, "maximum": 608.58, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 259.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 160.98 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.91 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 216.46, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.31 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 178.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 251.1, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.31 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 259.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 181.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 242.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 259.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 176.63, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 251.1, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.38 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 259.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 160.98 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 190.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 259.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 259.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 160.98 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 153.31 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 173.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 259.24, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 153.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 173.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 160.98 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 185.29, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 259.24, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CELL CT/DIFF.BODY FLD", "code_information": [ { "code": "89051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 187.0, "discounted_cash": 5.0, "minimum": 5.6, "maximum": 183.26, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.38, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.15 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.8 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.12, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.8 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.38, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 7.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.38, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.71, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.12, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.04 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.38, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.38, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.38, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 11.8 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.38, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.39 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 5.99, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.38, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHEST PAIN - SOI : 4", "code_information": [ { "code": "2034", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7235.31, "maximum": 8307.82, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 8307.82 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 8149.58 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 7912.21 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 7912.21 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 8070.46 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 8307.82 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 7235.31 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 7912.21 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 8307.82 } ] } ] }, { "description": "CHEMO IV PUSH EA ADDITIONAL DR", "code_information": [ { "code": "96411", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 179.25, "discounted_cash": 67.0, "minimum": 53.775, "maximum": 175.665, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.94 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.74 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 84.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.94 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 69.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 98.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.94 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 71.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 94.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 98.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.14 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.94 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 74.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 62.94 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 59.94 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.94 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 72.52, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHROMO, QT, COLUMN, NES", "code_information": [ { "code": "82542", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 303.0, "discounted_cash": 24.0, "minimum": 19.8, "maximum": 621.32, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 24.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.93, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 33.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.57, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.93, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 26.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.78, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.06, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CELLULITIS & OTHER SKIN INFECTIONS - SOI : 2", "code_information": [ { "code": "3832", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5191.6, "maximum": 5951.52, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 5951.52 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5838.16 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5668.11 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 5668.11 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5781.47 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 5951.52 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 5191.6 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5668.11 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5951.52 } ] } ] }, { "description": "CHEST TUBE INSERTION", "code_information": [ { "code": "32551", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2948.91, "discounted_cash": 1481.0, "minimum": 884.673, "maximum": 2948.91, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2218.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2948.91 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2948.91 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1481.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1852.46, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2948.91 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1556.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 1526.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2148.86, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2948.91 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1481.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2218.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1556.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 2074.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2218.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1511.61, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2148.86, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2948.91 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1481.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2218.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2948.91 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1630.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2218.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2218.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 2948.91 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2948.91 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1481.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2218.51, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2948.91 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1481.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1481.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 1481.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2948.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1481.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1585.71, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2218.51, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHEMO UNSP 96416 PLUS PUMP", "code_information": [ { "code": "96549", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 113.64, "discounted_cash": 44.0, "minimum": 34.092, "maximum": 113.64, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.64 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.64 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 55.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.64 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 45.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.64 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 46.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 61.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.96, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.92, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.64 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.64 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 48.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 113.64 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 113.64 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.64 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 47.17, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.99, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHROMO: THIN LAYER ANALYTE NOS", "code_information": [ { "code": "84999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 67.0, "minimum": 20.1, "maximum": 392.0, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 } ] } ] }, { "description": "CENTRAL VENOUS CATH INSERTION", "code_information": [ { "code": "36556", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1151.38, "discounted_cash": 2972.0, "minimum": 345.414, "maximum": 7502.3018, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1151.38, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1151.38 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1151.38 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1151.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1151.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1151.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1151.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 1151.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1151.38, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1151.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1151.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1151.38, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1151.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 1151.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1151.38, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1151.38, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1151.38, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1151.38 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1151.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1151.38, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1151.38 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1151.38, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1151.38, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1151.38, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 1151.38 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1151.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1151.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1151.38, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1151.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1151.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1151.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 1151.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1151.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1151.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1151.38, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1151.38, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHG PBD CATHETER", "code_information": [ { "code": "47531", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8733.48, "discounted_cash": 3370.0, "minimum": 132.0, "maximum": 14441.868, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5045.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3370.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4213.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3539.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 3471.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4887.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3370.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5045.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3539.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 4719.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5045.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3438.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4887.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3370.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5045.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 3707.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5045.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5045.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1305.59 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3370.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 5045.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3370.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3370.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 3370.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3370.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3606.68, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5045.98, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY FOR ACUTE LEUKEMIA - SOI : 1", "code_information": [ { "code": "6951", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8267.33, "maximum": 9497.7, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 9497.7 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 9316.79 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9045.42 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 9045.42 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9226.33 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 9497.7 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 8267.33 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9045.42 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9497.7 } ] } ] }, { "description": "CHRONIC KIDNEY DISEASE - SOI : 1", "code_information": [ { "code": "4701", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5530.91, "maximum": 6342.73, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 6342.73 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6221.92 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6040.7 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 6040.7 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6161.51 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 6342.73 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 5530.91 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6040.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6342.73 } ] } ] }, { "description": "CENTRALIZER VERSYS DISTA 16MM", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 9772.77, "10th_percentile": 9772.77, "90th_percentile": 36144.0, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 36381.0, "10th_percentile": 36381.0, "90th_percentile": 36381.0, "count": "1 through 10" } ] } ] }, { "description": "CHLAMYDIA ABS IGM", "code_information": [ { "code": "86632", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 46.0, "discounted_cash": 12.0, "minimum": 12.68, "maximum": 45.08, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.29 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 17.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.93, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.98, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.57, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.98, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHEST PAIN", "code_information": [ { "code": "313", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5862.0, "minimum": 5592.22, "maximum": 12018.3915, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7099.64, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5862.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7328.29, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6155.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 6038.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 8500.81, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 5862.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7099.64, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6155.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 7621.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7099.64, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 5979.88, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8500.81, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 5862.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7099.64, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 9380.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6448.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7099.64, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7099.64, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 10845.87, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 12018.39, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5862.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7099.64, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5862.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5592.22 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 5862.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5862.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 6273.01, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7099.64, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CHRONIC KIDNEY DISEASE - SOI : 3", "code_information": [ { "code": "4703", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9193.8, "maximum": 10565.87, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 10565.87 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 10364.62 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 10062.74 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 10062.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 10263.99 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 10565.87 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 9193.8 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 10062.74 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 10565.87 } ] } ] }, { "description": "CENTRALIZER VERSYS DISTAL 11MM", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 9772.77, "10th_percentile": 9772.77, "90th_percentile": 36144.0, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 36381.0, "10th_percentile": 36381.0, "90th_percentile": 36381.0, "count": "1 through 10" } ] } ] }, { "description": "CHLORAMPHENICOL", "code_information": [ { "code": "82415", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 46.0, "discounted_cash": 12.0, "minimum": 12.67, "maximum": 45.08, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.31 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.82 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.84, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.1 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.1 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 17.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.58 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.31 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.31 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 24.1 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.31 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 13.56, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHEST PAIN - SOI : 1", "code_information": [ { "code": "2031", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3438.72, "maximum": 3930.54, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 3930.54 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 3855.67 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 3743.37 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 3743.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 3818.24 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 3930.54 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 3438.72 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 3743.37 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 3930.54 } ] } ] }, { "description": "CHRONIC KIDNEY DISEASE - SOI : 4", "code_information": [ { "code": "4704", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15273.34, "maximum": 17575.3, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 17575.3 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 17240.53 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 16738.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 16738.38 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 17073.15 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 17575.3 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 15273.34 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 16738.38 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 17575.3 } ] } ] }, { "description": "CENTRALIZER VERSYS DISTAL 12MM", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 9772.77, "10th_percentile": 9772.77, "90th_percentile": 36144.0, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 36381.0, "10th_percentile": 36381.0, "90th_percentile": 36381.0, "count": "1 through 10" } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC", "code_information": [ { "code": "414", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25125.0, "minimum": 25125.1, "maximum": 51506.4755, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30426.51, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 25125.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 31406.39, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 26381.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 25878.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 36431.41, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 25125.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30426.51, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 26381.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 32662.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30426.51, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 25627.6, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 36431.41, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25125.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30426.51, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 40200.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 27637.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30426.51, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30426.51, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 46481.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 51506.48, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 25125.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30426.51, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25125.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33184.7 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 25125.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 25125.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 26883.87, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30426.51, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CHIP CANCELLOUS 5CC", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC", "code_information": [ { "code": "191", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6696.0, "minimum": 6696.12, "maximum": 13727.046, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8109.0, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 6696.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8370.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7030.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 6897.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 9709.37, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 6696.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8109.0, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 7030.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 8704.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8109.0, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 6830.04, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9709.37, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6696.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8109.0, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 10713.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 7365.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8109.0, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8109.0, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 12387.82, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 13727.05, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6696.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8109.0, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6696.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6855.03 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 6696.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 6696.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 7164.85, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8109.0, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CERVICAL MYELOGRAM", "code_information": [ { "code": "72240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2075.25, "discounted_cash": 738.0, "minimum": 500.8852, "maximum": 2033.745, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1104.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 525.93 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 515.92 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 738.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 922.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 500.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 774.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 760.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1070.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 500.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 738.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1104.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 774.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 1033.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1104.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 752.77, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1070.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 510.91 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 738.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1104.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 525.93 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 811.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1104.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1104.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 525.93 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 500.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 738.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1104.8, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 500.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 738.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 738.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 738.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 525.93 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 738.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 789.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1104.8, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY- SOI : 4", "code_information": [ { "code": "2634", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20247.38, "maximum": 23310.12, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 23310.12 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 22866.12 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 22200.11 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 22200.11 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 22644.11 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 23310.12 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 20247.38 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 22200.11 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 23310.12 } ] } ] }, { "description": "CHLAMYDIA TRACH DNA AMP PRB LC", "code_information": [ { "code": "87491", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 57.75, "discounted_cash": 35.0, "minimum": 17.325, "maximum": 313.6, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 19.88, "10th_percentile": 19.88, "90th_percentile": 19.88, "count": "1 through 10" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 304.0, "10th_percentile": 304.0, "90th_percentile": 304.0, "count": "1 through 10" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.79, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 291.2, "10th_percentile": 63.7, "90th_percentile": 291.2, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 38.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 54.0, "median_amount": 80.48, "10th_percentile": 80.48, "90th_percentile": 80.48, "count": "1 through 10" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 44.26 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 257.28, "10th_percentile": 257.28, "90th_percentile": 257.28, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.55, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.53, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CIRC W/O CLAMP/DEV/DOR >28DAYS", "code_information": [ { "code": "54161", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5087.04, "discounted_cash": 1967.0, "minimum": 1526.112, "maximum": 4985.2992, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2287.22 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1967.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2946.05, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2354.49 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 2164.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2946.05, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2946.05, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 2354.49 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1569.83 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1967.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2946.05, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2242.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1967.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1967.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 1967.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2354.49 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1967.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2105.73, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2946.05, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2946.05, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2354.49 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2309.64 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1967.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2459.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2242.37 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2066.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 2027.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2853.56, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2242.37 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1967.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2946.05, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2066.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 2755.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2946.05, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2007.33, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2853.56, "additional_payer_notes": "145.00% of Medicare Rates" } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "473", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17526.0, "minimum": 7200.0, "maximum": 35929.899, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21224.93, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 17526.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 21908.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18403.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 18052.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 25413.83, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 17526.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21224.93, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 18403.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 22784.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21224.93, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 17877.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 25413.83, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 17526.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21224.93, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 28042.85, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 19279.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21224.93, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21224.93, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 32424.54, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 35929.9, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 17526.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21224.93, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17526.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20102.6 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 17526.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 17526.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 18753.65, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21224.93, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CHOLINESTERASE, RBC", "code_information": [ { "code": "82482", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28.0, "discounted_cash": 9.0, "minimum": 8.4, "maximum": 27.44, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.26, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 10.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.01, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 10.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHLAMYDIA TRACHOMATIS AG EIT", "code_information": [ { "code": "87320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 15.0, "minimum": 13.2, "maximum": 43.12, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.56 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.75, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 21.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.75, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.34 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 16.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 22.46, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 15.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.05, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.46, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC", "code_information": [ { "code": "432", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14320.0, "minimum": 14320.88, "maximum": 29357.804, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17342.59, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 14320.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 17901.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15036.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 14750.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 20765.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 14320.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17342.59, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15036.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 18617.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17342.59, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 14607.32, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 20765.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 14320.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17342.59, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 22913.41, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 15752.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17342.59, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17342.59, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 26493.63, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 29357.8, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14320.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17342.59, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14320.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16902.9 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 14320.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14320.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 15323.34, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17342.59, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CESAREAN DELIVERY - SOI : 3", "code_information": [ { "code": "5403", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7426.07, "maximum": 9526.54, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 9526.54 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 9345.08 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 9072.9 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 9072.9 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9254.35 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 9526.54 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 7426.07 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 9072.9 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9526.54 } ] } ] }, { "description": "CHLAMYDIA TRACHOMATIS AG, IFT", "code_information": [ { "code": "87270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 11.0, "minimum": 11.98, "maximum": 43.12, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.56 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.34 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.82, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CITRATE", "code_information": [ { "code": "82507", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100.0, "discounted_cash": 27.0, "minimum": 27.46, "maximum": 98.0, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.62, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.83 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.28 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.46 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 28.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.31, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.46 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.62, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 38.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.62, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.36, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.31, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.01 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.62, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.83 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 30.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.62, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.62, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 28.83 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 27.46 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.62, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.83 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 29.75, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.62, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITH CC", "code_information": [ { "code": "784", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8167.0, "minimum": 7540.0, "maximum": 16742.9035, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9890.56, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8167.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10209.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8575.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 8412.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 11842.54, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 8167.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9890.56, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8575.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 10617.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9890.56, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 8330.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11842.54, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8167.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9890.56, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 7540.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 8984.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9890.56, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9890.56, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 15109.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 16742.9, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8167.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9890.56, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8167.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7836.28 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 8167.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8167.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 8738.98, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9890.56, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CHROM ANALYSIS; CNT 15-20 CELLS, 2 KARYOTYPES, W/BANDING", "code_information": [ { "code": "88262", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 315.0, "discounted_cash": 125.0, "minimum": 94.5, "maximum": 308.7, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.86, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.99 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.78 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 156.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 110.47 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 129.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 110.47 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.86, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 131.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 175.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.86, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.96, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.68 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.86, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.99 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 138.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.86, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.86, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 115.99 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 110.47 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.86, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 110.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.27, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.86, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHLORIDE URINE", "code_information": [ { "code": "82436", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18.0, "discounted_cash": 5.0, "minimum": 5.4, "maximum": 17.64, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.19, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 5.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.34, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.34, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6.15, "additional_payer_notes": "107.00% of Medicare Rates" } ] } ] }, { "description": "CL TR TIB SHF FX W/WO FB W/OMA", "code_information": [ { "code": "27750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 496.42, "discounted_cash": 232.0, "minimum": 148.926, "maximum": 644.7, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 290.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 239.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 336.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 243.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 325.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 236.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 336.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 255.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 496.42 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 248.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION- SOI : 4", "code_information": [ { "code": "5394", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14545.46, "maximum": 18768.78, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 18768.78 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 18411.27 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 17875.02 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 17875.02 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 18232.52 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 18768.78 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 14545.46 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 17875.02 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 18768.78 } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE - SOI : 1", "code_information": [ { "code": "1401", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4426.18, "maximum": 5069.03, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 5069.03 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4972.48 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4827.65 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 4827.65 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4924.2 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 5069.03 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 4426.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4827.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5069.03 } ] } ] }, { "description": "CHNG CYSTOSTOMY TUBE SMPL", "code_information": [ { "code": "51705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1033.05, "discounted_cash": 235.0, "minimum": 65.38, "maximum": 1304.086, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.65 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 67.34 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 294.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.38 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 246.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 242.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.05, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.38 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 246.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 329.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 239.91, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 341.05, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 66.69 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.65 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 258.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 68.65 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 65.38 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.65 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 235.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 251.67, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 352.11, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CLAMP LARGE COMBINATION MRI SA", "code_information": [ { "code": "A4649", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 1308.65, "10th_percentile": 1308.65, "90th_percentile": 1308.65, "count": "1 through 10" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH CC", "code_information": [ { "code": "787", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8551.0, "minimum": 7540.0, "maximum": 17530.5545, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10355.85, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8551.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10689.36, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8979.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 8808.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 12399.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 8551.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10355.85, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8979.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 11116.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10355.85, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 8722.52, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12399.66, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8551.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10355.85, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 7540.0, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9406.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10355.85, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10355.85, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 15820.26, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 17530.55, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8551.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10355.85, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8551.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11599.1 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 8551.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8551.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 9150.09, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10355.85, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE - SOI : 2", "code_information": [ { "code": "1402", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4993.79, "maximum": 5723.46, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 5723.46 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 5614.44 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 5450.91 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 5450.91 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 5559.93 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 5723.46 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 4993.79 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 5450.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 5723.46 } ] } ] }, { "description": "CHOLANGIOGRAPHY ORAL CONTRAST", "code_information": [ { "code": "74290", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 268.0, "discounted_cash": 165.0, "minimum": 80.4, "maximum": 262.64, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 247.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 197.07 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 193.32 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 165.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 206.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 187.69 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 170.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 239.44, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 187.69 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 165.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 247.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 173.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 231.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 247.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 239.44, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 191.44 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 165.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 247.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 197.07 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 181.64, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 247.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 247.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 197.07 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 187.69 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 165.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 247.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 187.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 165.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 165.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 165.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 197.07 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 165.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 176.69, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 247.2, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CLARISCAN 10 MMOL/20 ML VIAL", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "00407294305", "type": "NDC" }, { "code": "A9575", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 32.89, "maximum": 34.5345, "payers_information": [ { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 44.5, "10th_percentile": 44.5, "90th_percentile": 44.5, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 39.32, "10th_percentile": 39.32, "90th_percentile": 39.32, "count": "1 through 10" } ] }, { "setting": "outpatient", "payers_information": [ { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 44.5, "10th_percentile": 44.5, "90th_percentile": 44.5, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 39.32, "10th_percentile": 39.32, "90th_percentile": 39.32, "count": "1 through 10" } ] } ] }, { "description": "CHANGE PERCUTANEOUS TUBE/CATH", "code_information": [ { "code": "75984", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 436.59, "minimum": 130.977, "maximum": 427.8582, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 155.72 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 152.75 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.3 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.3 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 151.27 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 155.72 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 155.72 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 148.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.3 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 155.72 } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC", "code_information": [ { "code": "190", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8489.0, "minimum": 7704.87, "maximum": 17404.131, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10281.17, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8489.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10612.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8914.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 8744.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 12310.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 8489.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10281.17, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8914.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 11036.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10281.17, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 8659.62, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12310.24, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8489.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10281.17, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 13583.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9338.8, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10281.17, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10281.17, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 15706.17, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 17404.13, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8489.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10281.17, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8489.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7704.87 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 8489.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8489.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 9084.11, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10281.17, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC", "code_information": [ { "code": "415", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14988.0, "minimum": 14988.35, "maximum": 30726.1175, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18150.89, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 14988.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18735.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15737.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 15438.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 21733.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 14988.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18150.89, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 15737.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 19484.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18150.89, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 15288.17, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 21733.11, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 14988.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18150.89, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 23981.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 16487.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18150.89, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18150.89, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 27728.45, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 30726.12, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 14988.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18150.89, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14988.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19157.2 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 14988.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 14988.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 16037.53, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18150.89, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CLD TX CLAVICULAR FX W/MAN", "code_information": [ { "code": "23505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3940.02, "discounted_cash": 1513.0, "minimum": 935.508, "maximum": 3861.2196, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2266.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1425.77 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1398.62 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1513.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1892.29, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1357.88 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1589.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 1559.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2195.05, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1357.88 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1513.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2266.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1589.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 2119.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2266.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1544.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2195.05, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1385.04 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1513.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2266.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1425.77 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1665.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2266.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2266.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 1425.77 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1357.88 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1513.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2266.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1357.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1513.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1513.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 1513.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1425.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1513.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1619.8, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2266.2, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHANGE TRACHEOSTOMY TUBE", "code_information": [ { "code": "31502", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 535.5, "discounted_cash": 222.0, "minimum": 141.669, "maximum": 524.79, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 333.79, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.75 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 145.92 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 222.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 278.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 141.67 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 234.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 229.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 323.31, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 141.67 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 222.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 333.79, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 234.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 312.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 333.79, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 227.43, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 323.31, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.5 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 222.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 333.79, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.75 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 245.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 333.79, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 333.79, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 148.75 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 141.67 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 222.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 333.79, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 141.67 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 222.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 222.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 222.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.75 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 222.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 238.58, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 333.79, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CCMCC", "code_information": [ { "code": "192", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5334.0, "minimum": 4272.24, "maximum": 10934.8435, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6459.56, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5334.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 6667.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5600.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 5494.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 7734.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 5334.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6459.56, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5600.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 6934.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6459.56, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 5440.75, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 7734.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 5334.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6459.56, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 8534.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 5867.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6459.56, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6459.56, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 9868.03, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 10934.84, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5334.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6459.56, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5334.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4272.24 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 5334.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5334.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 5707.45, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6459.56, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "416", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10221.0, "minimum": 10221.86, "maximum": 20954.813, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12378.67, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 10221.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12777.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10733.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 10528.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 14821.7, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 10221.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12378.67, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10733.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 13288.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12378.67, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 10426.34, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14821.7, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10221.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12378.67, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 16354.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 11244.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12378.67, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12378.67, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 18910.44, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 20954.81, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10221.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12378.67, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10221.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19385.9 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 10221.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 10221.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 10937.39, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12378.67, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "Clear outer ear canal", "code_information": [ { "code": "69200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 319.44, "discounted_cash": 125.0, "minimum": 83.92, "maximum": 730.4528, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 156.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 129.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 131.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 175.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 127.76, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.61, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 137.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 83.92 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.02, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.5, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHECKOUT ORTHO/PROS, EA 15 MIN", "code_information": [ { "code": "97763", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 211.82, "discounted_cash": 47.0, "minimum": 27.489, "maximum": 207.5836, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 70.61, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 58.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 48.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 70.61, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 49.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 66.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 70.61, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 68.4, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 70.61, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 51.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 70.61, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 70.61, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 111.97 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 47.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 70.61, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 47.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 47.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 50.47, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.61, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [ { "code": "287", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8235.0, "minimum": 8235.03, "maximum": 16881.8115, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9972.62, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 8235.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10293.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8646.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 8482.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 11940.79, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 8235.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9972.62, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8646.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 10705.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9972.62, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 8399.73, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11940.79, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8235.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9972.62, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 13176.05, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 9058.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9972.62, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9972.62, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 15234.81, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 16881.81, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 8235.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9972.62, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8235.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10342.3 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 8235.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 8235.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 8811.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9972.62, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CHROM ANA;ADDL KARO;EA STUDY", "code_information": [ { "code": "88280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1651.04, "discounted_cash": 33.0, "minimum": 33.47, "maximum": 1618.0192, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 50.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.99 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.78 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.84, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 110.47 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 34.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.53, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 110.47 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 50.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 46.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 50.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.53, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.68 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 50.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.99 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 36.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 50.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 50.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 115.99 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 110.47 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 33.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 50.1, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 110.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 33.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.99 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.81, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.1, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CLEFT LIP & PALATE REPAIR - SOI : 4", "code_information": [ { "code": "0954", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11414.21, "maximum": 13125.9, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 13125.9 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 12875.88 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 12500.86 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 12500.86 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 12750.88 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 13125.9 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 11414.21 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 12500.86 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 13125.9 } ] } ] }, { "description": "Chemical cautery tissue", "code_information": [ { "code": "17250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 506.85, "discounted_cash": 188.0, "minimum": 152.055, "maximum": 496.713, "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 236.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 198.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 194.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 273.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 198.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 264.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.66, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 273.88, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 207.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 222.13 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 202.1, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 282.75, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CIRCUMCISION W/REGIONL BLOCK", "code_information": [ { "code": "54150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5087.04, "minimum": 1526.112, "maximum": 4985.2992, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2354.49 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2309.64 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2242.37 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2242.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2287.22 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2354.49 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 2354.49 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1569.83 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2242.37 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2354.49 } ] } ] }, { "description": "CHROMA, QT: MULTIPLE ANALYTES", "code_information": [ { "code": "82542", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 306.0, "discounted_cash": 24.0, "minimum": 19.8, "maximum": 621.32, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 24.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.93, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 33.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.57, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.93, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 26.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.78, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.06, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "Clozapine", "code_information": [ { "code": "80159", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20.0, "discounted_cash": 20.0, "minimum": 6.0, "maximum": 20.0, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHEMICAL PLEURODESIS", "code_information": [ { "code": "32560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1837.71, "discounted_cash": 590.0, "minimum": 551.313, "maximum": 1837.71, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 884.07, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1837.71 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1837.71 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 590.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 738.2, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1837.71 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 620.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 608.28, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 856.31, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1837.71 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 590.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 884.07, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 620.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 826.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 884.07, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 602.37, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 856.31, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1837.71 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 590.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 884.07, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1837.71 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 649.62, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 884.07, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 884.07, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 1837.71 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1837.71 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 590.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 884.07, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1837.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 590.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 590.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 590.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1837.71 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 590.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 631.9, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 884.07, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CCMCC", "code_information": [ { "code": "434", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5811.0, "minimum": 5672.43, "maximum": 11914.2105, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7038.1, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 5811.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 7264.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6102.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 5986.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 8427.12, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 5811.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7038.1, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 6102.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 7555.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7038.1, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 5928.05, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8427.12, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 5811.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7038.1, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 9298.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 6392.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7038.1, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7038.1, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 10751.85, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 11914.21, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 5811.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7038.1, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5811.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5672.43 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 5811.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 5811.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 6218.64, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7038.1, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CHROMATOGRAPHY, QT, SINGLE", "code_information": [ { "code": "82542", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 66.0, "discounted_cash": 24.0, "minimum": 19.8, "maximum": 621.32, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 24.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.93, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 33.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.57, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.93, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 26.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 36.06, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.78, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.06, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CLS FX FEM DIS END M/L W/O MAN", "code_information": [ { "code": "27508", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 496.42, "discounted_cash": 232.0, "minimum": 148.926, "maximum": 644.7, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 290.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 239.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 336.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 243.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 325.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 236.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 336.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 255.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 496.42 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 248.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHEMISTRY TEST", "code_information": [ { "code": "84999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 400.0, "minimum": 20.1, "maximum": 392.0, "payers_information": [ { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 } ] } ] }, { "description": "CKMB FRACTION ONLY", "code_information": [ { "code": "82553", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 217.02, "discounted_cash": 11.0, "minimum": 11.55, "maximum": 212.6796, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.29, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 11.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.29, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.29, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.78, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.29, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 12.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.29, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.29, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.29, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 11.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.36, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.29, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHROMIUM", "code_information": [ { "code": "82495", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.1, "discounted_cash": 20.0, "minimum": 20.28, "maximum": 164.738, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.36, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.41 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.98 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.34 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 20.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.41, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.34 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.36, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 28.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.36, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.69, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.41, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.77 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.36, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.41 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 22.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.36, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.36, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 22.41 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 21.34 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 30.36, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.41 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.36, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CLS TR DIS FIB FX LM W/O MAN", "code_information": [ { "code": "27786", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 496.42, "discounted_cash": 232.0, "minimum": 148.926, "maximum": 644.7, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 290.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 239.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 336.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 243.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 325.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 236.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 336.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 255.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 496.42 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 248.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHEMO, IV INFUSION, ADDL HR", "code_information": [ { "code": "96415", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 179.25, "discounted_cash": 67.0, "minimum": 53.775, "maximum": 179.25, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.25 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.25 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 84.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.25 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 69.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 98.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.25 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 71.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 94.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 69.14, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 98.28, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.25 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.25 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 74.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 179.25 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 179.25 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.25 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 67.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 72.52, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 101.47, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CL TR METATARSL FX W/O MAN EA", "code_information": [ { "code": "28470", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 496.42, "discounted_cash": 232.0, "minimum": 148.926, "maximum": 644.7, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 290.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 239.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 336.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 243.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 325.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 236.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 336.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 255.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 496.42 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 248.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHRONIC KIDNEY DISEASE - SOI : 2", "code_information": [ { "code": "4702", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5530.91, "maximum": 6342.73, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 6342.73 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6221.92 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6040.7 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 6040.7 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6161.51 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 6342.73 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 5530.91 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6040.7 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6342.73 } ] } ] }, { "description": "CLS TRT BIMAL ANKL FX W/O MAN", "code_information": [ { "code": "27808", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 496.42, "discounted_cash": 232.0, "minimum": 148.926, "maximum": 644.7, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 290.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 239.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 336.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 243.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 325.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 236.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 336.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 255.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 496.42 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 248.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY FOR ACUTE LEUKEMIA - SOI : 4", "code_information": [ { "code": "6954", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 61741.66, "maximum": 71151.06, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 71151.06 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 69795.8 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 67762.91 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 67762.91 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 69118.17 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 71151.06 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 61741.66 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 67762.91 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 71151.06 } ] } ] }, { "description": "CLAMP MULTI PIN LARGE 6 POSITI", "code_information": [ { "code": "A4649", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 1308.65, "10th_percentile": 1308.65, "90th_percentile": 1308.65, "count": "1 through 10" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE - SOI : 3", "code_information": [ { "code": "1403", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5763.11, "maximum": 6610.45, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 6610.45 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 6484.54 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 6295.67 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 6295.67 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 6421.58 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 6610.45 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 5763.11 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 6295.67 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 6610.45 } ] } ] }, { "description": "CLS TRT FX MTEGAI TY ELBO W/MA", "code_information": [ { "code": "24620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3118.36, "discounted_cash": 1513.0, "minimum": 935.508, "maximum": 3861.2196, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2266.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1425.77 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1398.62 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1513.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1892.29, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1357.88 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1589.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 1559.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2195.05, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1357.88 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1513.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2266.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1589.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 2119.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2266.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1544.11, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2195.05, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1385.04 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1513.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2266.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1425.77 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 1665.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2266.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2266.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 1425.77 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1357.88 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1513.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 2266.2, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1357.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1513.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1513.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 1513.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1425.77 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1513.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1619.8, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2266.2, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC", "code_information": [ { "code": "847", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9848.0, "minimum": 7710.84, "maximum": 20189.384, "payers_information": [ { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11926.51, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial", "methodology": "case rate", "standard_charge_dollar": 18219.69, "additional_payer_notes": "185.00% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Commercial Plus", "methodology": "case rate", "standard_charge_dollar": 20189.38, "additional_payer_notes": "205.00% of Medicare Rates" }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 9848.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11926.51, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9848.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7710.84 }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "case rate", "standard_charge_dollar": 9848.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 9848.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "case rate", "standard_charge_dollar": 10537.87, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11926.51, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11926.51, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "case rate", "standard_charge_dollar": 9848.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12310.6, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10340.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "case rate", "standard_charge_dollar": 10143.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "case rate", "standard_charge_dollar": 14280.3, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "case rate", "standard_charge_dollar": 9848.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11926.51, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "case rate", "standard_charge_dollar": 10340.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "case rate", "standard_charge_dollar": 12803.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11926.51, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "case rate", "standard_charge_dollar": 10045.45, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14280.3, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9848.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11926.51, "additional_payer_notes": "121.10% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC.", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC. (NHSI) AND INDEPENDENT MEDICAL SOLUTIONS (IMS)", "methodology": "case rate", "standard_charge_dollar": 15757.57, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "case rate", "standard_charge_dollar": 10833.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11926.51, "additional_payer_notes": "121.10% of Medicare Rates" } ] } ] }, { "description": "CLAREON IOL LENS 10.5D", "code_information": [ { "code": "V2632", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 1311.73, "10th_percentile": 1311.73, "90th_percentile": 1478.14, "count": "1 through 10" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 1585.22, "10th_percentile": 1585.22, "90th_percentile": 1585.22, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 1400.57, "10th_percentile": 1400.57, "90th_percentile": 1400.57, "count": "1 through 10" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE - SOI : 4", "code_information": [ { "code": "1404", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8192.28, "maximum": 9411.16, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 9411.16 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 9231.9 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 8963.01 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 8963.01 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 9142.27 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 9411.16 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 8192.28 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 8963.01 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 9411.16 } ] } ] }, { "description": "CLS TRT TALUS FX W/O MAN", "code_information": [ { "code": "28430", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 496.42, "discounted_cash": 232.0, "minimum": 148.926, "maximum": 644.7, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 290.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 239.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 336.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 243.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 325.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 236.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 336.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 255.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 496.42 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 248.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHEST PAIN - SOI : 2", "code_information": [ { "code": "2032", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4297.95, "maximum": 4921.2, "payers_information": [ { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "case rate", "standard_charge_dollar": 4921.2 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "case rate", "standard_charge_dollar": 4827.46 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "case rate", "standard_charge_dollar": 4686.86 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "case rate", "standard_charge_dollar": 4686.86 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "case rate", "standard_charge_dollar": 4780.59 }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "case rate", "standard_charge_dollar": 4921.2 }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "case rate", "standard_charge_dollar": 4297.95 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "case rate", "standard_charge_dollar": 4686.86 }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "case rate", "standard_charge_dollar": 4921.2 } ] } ] }, { "description": "CLAREON IOL LENS 13.3D", "code_information": [ { "code": "V2632", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 1311.73, "10th_percentile": 1311.73, "90th_percentile": 1478.14, "count": "1 through 10" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 91.0, "median_amount": 1585.22, "10th_percentile": 1585.22, "90th_percentile": 1585.22, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 1400.57, "10th_percentile": 1400.57, "90th_percentile": 1400.57, "count": "1 through 10" } ] } ] }, { "description": "CL TR FX DIS TIB W/WO ANE WO M", "code_information": [ { "code": "27824", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 496.42, "discounted_cash": 232.0, "minimum": 148.926, "maximum": 644.7, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 496.42 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 496.42 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 290.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 496.42 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 239.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 336.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 496.42 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 243.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 325.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 236.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 336.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 496.42 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 496.42 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 255.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 496.42 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 496.42 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 496.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 496.42 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 248.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CLS TRT ULNR FX PRX END W/O MA", "code_information": [ { "code": "24670", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 496.42, "discounted_cash": 232.0, "minimum": 148.926, "maximum": 644.7, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 496.42 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 496.42 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 290.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 496.42 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 239.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 336.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 496.42 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 243.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare - Surgery Plus", "methodology": "fee schedule", "standard_charge_dollar": 325.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "HEALTHSMART", "plan_name": "HEALTHSMART Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Med Mutual Of OH", "plan_name": "Med Mutual Of OH Medicare", "methodology": "fee schedule", "standard_charge_dollar": 236.86, "additional_payer_notes": "102.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 336.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 496.42 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MULTIPLAN", "plan_name": "MULTIPLAN Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Paramount", "plan_name": "Paramount Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 496.42 }, { "payer_name": "PERENNIAL ADVANTAGE", "plan_name": "PERENNIAL ADVANTAGE", "methodology": "fee schedule", "standard_charge_dollar": 255.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "PROVIDER NETWORK OF AMERICA", "plan_name": "PROVIDER NETWORK OF AMERICA Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "PROVIDER SELECT", "plan_name": "PROVIDER SELECT Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Quality Care Partner", "plan_name": "Quality Care Partner Medicaid (Paramount - Medicaid HMO)", "methodology": "fee schedule", "standard_charge_dollar": 496.42 }, { "payer_name": "Standard EAPG Logic", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 496.42 }, { "payer_name": "The Health Plan", "plan_name": "The Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "THREE RIVERS", "plan_name": "THREE RIVERS Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 496.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC - VACCA", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 496.42 }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Valor Health Plan", "plan_name": "Valor Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 248.48, "additional_payer_notes": "107.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" } ] } ] }, { "description": "CHIP CANCELLOUS 30CC", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Commercial Traditional", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.3, "median_amount": 4969.68, "10th_percentile": 84.54, "90th_percentile": 21904.77, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 95.0, "median_amount": 5156.13, "10th_percentile": 5156.13, "90th_percentile": 5156.13, "count": "1 through 10" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.4, "median_amount": 603.0, "10th_percentile": 603.0, "90th_percentile": 603.0, "count": "1 through 10" } ] } ] }, { "description": "CLAVICAL DISLOCAT W MANIP-BILA", "code_information": [ { "code": "23545", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 496.42, "discounted_cash": 232.0, "minimum": 148.926, "maximum": 675.27, "payers_information": [ { "payer_name": "AMERICAS CHOICE PROVIDER NETWORK", "plan_name": "AMERICAS CHOICE PROVIDER NETWORK (ACPN) Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "payer_name": "Amerihealth Caritas", "plan_name": "Amerihealth Caritas Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 496.42 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 496.42 }, { "payer_name": "Anthem BCBS", "plan_name": "Anthem BCBS Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 290.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Community Health Plan Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 496.42 }, { "payer_name": "Buckeye Community Health Plan", "plan_name": "Buckeye Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 243.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Duals", "methodology": "fee schedule", "standard_charge_dollar": 239.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Exchange", "methodology": "fee schedule", "standard_charge_dollar": 336.72, "additional_payer_notes": "145.00% of Medicare Rates" }, { "payer_name": "Care Source", "plan_name": "Caresource Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 496.42 }, { "payer_name": "Care Source", "plan_name": "Caresource Medicare", "methodology": "fee schedule", "standard_charge_dollar": 232.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "CORVEL", "plan_name": "CORVEL Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 347.63, "additional_payer_notes": "149.70% of Medicare Rates" }, { "p